Organization
BLUE RIDGE MEDICAL MANAGEMENT CORPORATION
Active
Other names
MSMG HIMA UCMH
Organization subpart
No
Provider details
NPI number
Authorized official
CARL STEVEN KILGORE (PRESIDENT)
(423) 915-5100
Entity
Organization
Contact information
Practice address
100 GREENWAY CIR, ERWIN, TN 37650-2177
(423) 431-1810
(423) 431-1811
Mailing address
100 GREENWAY CIR, ERWIN, TN 37650-2177
(423) 431-1810
(423) 431-1811
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
208M00000X
Hospitalist Physician
—
—
363A00000X
Physician Assistant
—
—
363L00000X
Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1912318635
—
VA
05
—
Q006137
—
TN
Enumeration date
05/15/2014
Last updated
12/03/2014
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