Organization
BLUE RIDGE MEDICAL MANAGEMENT CORPORATION
Active
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
Update your record
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