Healthcare Provider Details

I. General information

NPI: 1467987917
Provider Name (Legal Business Name): BLUE RIDGE MEDICAL MANAGEMENT CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/21/2017
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

428 E VANN RD
GREENEVILLE TN
37743-7202
US

IV. Provider business mailing address

428 E VANN RD
GREENEVILLE TN
37743-7202
US

V. Phone/Fax

Practice location:
  • Phone: 423-278-1950
  • Fax: 423-278-1973
Mailing address:
  • Phone: 423-278-1950
  • Fax: 423-278-1973

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: CARL STEVEN KILGORE
Title or Position: PRESIDENT/CEO
Credential:
Phone: 423-302-3051