Organization
BLUE RIDGE MEDICAL MANAGEMENT CORPORATION
Active
Other names
MSMG PULMONOLOGY of KINGSPORT A
Organization subpart
No
Provider details
NPI number
Authorized official
CARL STEVEN KILGORE (PRESIDENT / CEO)
(423) 915-5100
Entity
Organization
Contact information
Practice address
444 CLINCHFIELD ST, UNIT 201A, KINGSPORT, TN 37660-3858
(423) 857-7650
(423) 857-7655
Mailing address
444 CLINCHFIELD ST, UNIT 201A, KINGSPORT, TN 37660-3858
(423) 857-7650
(423) 857-7655
Taxonomy
Speciality
Code
Description
License number
State
207RP1001X
Pulmonary Disease Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1699188276
—
VA
05
—
Q009979
—
TN
Enumeration date
06/11/2014
Last updated
02/14/2017
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