Healthcare Provider Details

I. General information

NPI: 1487765624
Provider Name (Legal Business Name): BLUE RIDGE MEDICAL MANAGEMENT CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 03/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

98 15TH ST NW STE 207
NORTON VA
24273-1600
US

IV. Provider business mailing address

98 15TH ST NW STE 207
NORTON VA
24273-1600
US

V. Phone/Fax

Practice location:
  • Phone: 276-439-1490
  • Fax: 276-439-1495
Mailing address:
  • Phone: 276-439-1490
  • Fax: 276-439-1495

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State

VIII. Authorized Official

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