Healthcare Provider Details

I. General information

NPI: 1437186368
Provider Name (Legal Business Name): BLUE RIDGE MEDICAL MANAGEMENT CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2006
Last Update Date: 02/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1019 W OAKLAND AVE SUITE 1
JOHNSON CITY TN
37604-2357
US

IV. Provider business mailing address

1019 W OAKLAND AVE SUITE 1
JOHNSON CITY TN
37604-2357
US

V. Phone/Fax

Practice location:
  • Phone: 423-915-5000
  • Fax: 423-915-5045
Mailing address:
  • Phone: 423-915-5000
  • Fax: 423-915-5045

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CARL STEVEN KILGORE
Title or Position: PRESIDENT
Credential:
Phone: 423-915-5185