Organization
BLUE RIDGE MEDICAL MANAGEMENT
Active
Other names
MSMG GEN SURG ERWIN
Organization subpart
No
Provider details
NPI number
Authorized official
CARL STEPHEN KILGORE (PRESIDENT)
(423) 915-5116
Entity
Organization
Contact information
Practice address
630 ONEEGA LN, SUITE D, ERWIN, TN 37650-2197
(423) 542-7440
(423) 542-7445
Mailing address
630 ONEEGA LN, SUITE D, ERWIN, TN 37650-2197
(423) 542-7440
(423) 542-7445
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
Q012234
—
TN
Enumeration date
03/05/2015
Last updated
02/14/2017
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