Organization
BLUE RIDGE MEDICAL MANAGEMENT CORPORATION
Active
Other names
MSMG Neuro KPT
Organization subpart
No
Provider details
NPI number
Authorized official
CARL S KILGORE (PRESIDENT)
(423) 915-5100
Entity
Organization
Contact information
Practice address
2212 N JOHN B DENNIS HWY, SUITE C, KINGSPORT, TN 37660-5894
(423) 224-3940
(423) 224-3946
Mailing address
2212 N JOHN B DENNIS HWY, SUITE C, KINGSPORT, TN 37660-5894
(423) 224-3940
(423) 224-3946
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1526970
—
TN
05
—
1639441066
—
VA
01
—
614862410
DEPARTMENT OF LABOR
TN
Enumeration date
02/01/2012
Last updated
02/14/2017
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