Organization
BLUE RIDGE MEDICAL MANAGEMENT CORPORATION
Active
Other names
MSMG GEN SURG MAR
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CARL STEVEN KILGORE (PRESIDENT)
(423) 915-5116
Entity
Organization
Contact information
Practice address
1020 TERRACE DR, SUITE 202, MARION, VA 24354-4392
(276) 781-7848
(276) 781-7849
Mailing address
1205 SNIDER ST, MARION, VA 24354-4221
(276) 781-7848
(276) 781-7849
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1548552458
—
VA
Enumeration date
05/11/2011
Last updated
06/18/2012
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