Organization
BLUE RIDGE MEDICAL MANAGEMENT CORPORATION
Active
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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