Healthcare Provider Details

I. General information

NPI: 1215395843
Provider Name (Legal Business Name): BLUE RIDGE MEDICAL MANAGEMENT CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/10/2016
Last Update Date: 05/02/2025
Certification Date: 05/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1616 N MAIN ST STE 100A
MARION VA
24354-4473
US

IV. Provider business mailing address

1616 N MAIN ST STE 100A
MARION VA
24354-4473
US

V. Phone/Fax

Practice location:
  • Phone: 276-783-9752
  • Fax: 276-783-7786
Mailing address:
  • Phone: 276-783-9752
  • Fax: 276-783-7786

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

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