Organization
BLUE RIDGE MEDICAL MANAGEMENT CORPORATION
Active
Other names
MSMG URO RURL
Organization subpart
No
Provider details
NPI number
Authorized official
CARL STEVEN KILGORE (PRESIDENT)
(423) 915-5116
Entity
Organization
Contact information
Practice address
7021 WEST LEE HIGHWAY, SUITE B, RURAL RETREAT, VA 24368
(276) 783-5400
(276) 783-5521
Mailing address
7021 WEST LEE HIGHWAY, SUITE B, RURAL RETREAT, VA 24368
(276) 783-5400
(276) 783-5521
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
—
—
363LF0000X
Family Nurse Practitioner
0024166068
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1811269640
—
VA
Enumeration date
02/09/2012
Last updated
02/14/2017
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