Organization
BLUE RIDGE MEDICAL MANAGEMENT CORPORATION
Active
Other names
MSMG OB GYN KPT B
Organization subpart
No
Provider details
NPI number
Authorized official
CARL STEVEN KILGORE (PRESIDENT)
(423) 915-5185
Entity
Organization
Contact information
Practice address
2002 BROOKSIDE DR, SUITE 200, KINGSPORT, TN 37660-4634
(423) 246-3500
(423) 847-6372
Mailing address
PO BOX 3700, JOHNSON CITY, TN 37602-3700
(866) 397-1439
(423) 262-1373
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3716291
—
TN
Enumeration date
08/11/2006
Last updated
10/27/2010
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