Organization
BLUE RIDGE MEDICAL MANAGEMENT CORPORATION
Active
Other names
TriCities Cancer Care
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CARL STEVEN KILGORE (PRESIDENT)
(423) 915-5121
Entity
Organization
Contact information
Practice address
2020 BROOKSIDE DRIVE, SUITE 20, KINGSPORT, TN 37660-4633
(423) 392-4673
(423) 932-4257
Mailing address
2020 BROOKSIDE DRIVE, SUITE 20, KINGSPORT, TN 37660-4633
(423) 392-4673
(423) 932-4257
Taxonomy
Speciality
Code
Description
License number
State
207RH0003X
Hematology & Oncology Physician
—
—
207RX0202X
Medical Oncology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1507568
—
TN
05
—
1538315452
—
VA
Enumeration date
08/12/2008
Last updated
09/07/2010
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