Organization
BLUE RIDGE MEDICAL MANAGEMENT CORPORATION
Active
Other names
DBA Indian Path Pavilion
Organization subpart
No
Provider details
NPI number
Authorized official
C. STEVEN KILGORE (SENIOR VICE PRESIDENT)
(423) 915-5185
Entity
Organization
Contact information
Practice address
2300 PAVILION DR, KINGSPORT, TN 37660-4622
(423) 392-5500
(423) 392-5597
Mailing address
2300 PAVILION DR, KINGSPORT, TN 37660-4622
(423) 392-5500
(423) 392-5597
Taxonomy
Speciality
Code
Description
License number
State
2084A0401X
Addiction Medicine (Psychiatry & Neurology) Physician
Primary
—
—
2084P0800X
Psychiatry Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3716292
—
TN
Enumeration date
09/12/2006
Last updated
09/11/2025
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