Organization
BLUE RIDGE MEDICAL MANAGEMENT CORPORATION
Active
Other names
MSMG URO ABG
Organization subpart
No
Provider details
NPI number
Authorized official
CARL STEVEN KILGORE (PRESIDENT)
(423) 915-5116
Entity
Organization
Contact information
Practice address
16000 JOHNSTON MEMORIAL DRIVE, SUITE 112A, ABINGDON, VA 24211
(276) 258-1740
(276) 258-1745
Mailing address
16000 JOHNSTON MEMORIAL DRIVE, SUITE 112A, ABINGDON, VA 24211
(423) 952-2122
(276) 258-1745
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1629362033
—
VA
Enumeration date
06/02/2011
Last updated
07/09/2015
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