Organization
BLUE RIDGE MEDICAL MANAGEMENT CORPORATION
Active
Other names
MSMG IM UNI
Organization subpart
No
Provider details
NPI number
Authorized official
CARL STEVEN KILGORE (PRESIDENT)
(423) 952-2122
Entity
Organization
Contact information
Practice address
3614 UNICOI DR, UNICOI, TN 37692-6860
(423) 743-7151
(423) 743-7059
Mailing address
509 MED TECH PKWY, SUITE 100, JOHNSON CITY, TN 37604-2578
(423) 952-2122
(423) 952-2147
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
363LF0000X
Family Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
020487840
DEPT OF LABOR
TN
05
—
1532914
—
TN
01
—
CA5744
RR MEDICARE
TN
Enumeration date
03/22/2013
Last updated
09/21/2015
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