Organization
BLUE RIDGE MEDICAL MANAGEMENT CORPORATION
Active
Other names
MSMG VAS SURG ABG
Organization subpart
No
Provider details
NPI number
Authorized official
CARL STEVEN KILGORE (PRESIDENT/CEO)
(423) 915-5121
Entity
Organization
Contact information
Practice address
16000 JOHNSTON MEMORIAL DR, SUITE 212 C, ABINGDON, VA 24211-7659
(276) 258-2014
(276) 258-3745
Mailing address
16000 JOHNSTON MEMORIAL DR, SUITE 212 C, ABINGDON, VA 24211-7659
(276) 258-2014
(276) 258-3745
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1467896597
—
VA
01
—
622524600
DEPARTMENT OF LABOR/BLACK LUNG & ENERGY
VA
Enumeration date
04/19/2013
Last updated
02/14/2017
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