Organization
BLUE RIDGE MEDICAL MANAGEMENT CORPORATION
Active
Organization
BLUE RIDGE MEDICAL MANAGEMENT CORPORATION
Active
Other names
MSMG IM LEB
Organization subpart
No
Provider details
NPI number
Authorized official
CARL STEVEN KILGORE (PRESIDENT)
(423) 915-5116
Entity
Organization
Contact information
Practice address
71 SOUTH FLANNAGAN AVE, LEBANON, VA 24266-4515
(276) 883-8030
(276) 883-8034
Mailing address
PO BOX 3700, JOHNSON CITY, TN 37602-3700
(866) 397-1439
(423) 262-1373
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1891958617
—
VA
Enumeration date
07/02/2008
Last updated
10/29/2010
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