Organization
BLUE RIDGE MEDICAL MANAGEMENT CORPORATION
Active
Other names
MSMG FP IM KPT
Organization subpart
No
Provider details
NPI number
Authorized official
CARL STEVEN KILGORE (PRESIDENT)
(423) 915-5185
Entity
Organization
Contact information
Practice address
2202 N JOHN B DENNIS HWY, SUITE 204, KINGSPORT, TN 37660-5904
(423) 229-7777
(423) 229-7776
Mailing address
2202 N JOHN B DENNIS PKWY, SUITE 204, KINGSPORT, TN 37660-5887
(423) 229-7777
(423) 229-7776
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3716296
—
TN
Enumeration date
04/09/2007
Last updated
03/31/2011
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