Organization
BLUE RIDGE MEDICAL MANAGEMENT CORPORATION
Active
Other names
MSMG FM Elizabethton B
Organization subpart
No
Provider details
NPI number
Authorized official
CARL STEVEN KILGORE (PRESIDENT)
(423) 915-5121
Entity
Organization
Contact information
Practice address
1497 W ELK AVE, SUITE 20, ELIZABETHTON, TN 37643-2895
(423) 542-7400
(423) 542-7405
Mailing address
1497 W ELK AVE, SUITE 20, ELIZABETHTON, TN 37643-2895
(423) 542-7400
(423) 542-7405
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1629432828
—
VA
05
—
Q020934
—
TN
Enumeration date
04/13/2016
Last updated
10/07/2016
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