Healthcare Provider Details

I. General information

NPI: 1639649296
Provider Name (Legal Business Name): BLUE RIDGE MEDICAL MANAGEMENT CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/27/2018
Last Update Date: 05/02/2025
Certification Date: 05/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

245 MEDICAL PARK DR
MARION VA
24354
US

IV. Provider business mailing address

245 MEDICAL PARK DR
MARION VA
24354
US

V. Phone/Fax

Practice location:
  • Phone: 276-378-1140
  • Fax: 276-378-1145
Mailing address:
  • Phone: 276-378-1140
  • Fax: 276-378-1145

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 Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

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