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General NPI Number Information
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NPI Number | 1144231119
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Entity Type | Organization
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Legal Business Name | BLUE RIDGE MEDICAL MANAGEMENT CORPORATION
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Dates
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Enumeration Date | 08/11/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2300 PAVILION DR
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City | KINGSPORT
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State | TN
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Zip | 37660-4622
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Country | US
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Telephone | 423-857-5720
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Fax | 423-857-5720
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Provider Business Mailing Address
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Address Line | 2300 PAVILION DR
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City | KINGSPORT
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State | TN
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Zip | 37660-4622
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Country | US
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Telephone | 423-857-5720
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Fax | 423-857-5720
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Authorized Official
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Title or Position | SENIOR VICE PRESIDENT
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Name | C STEVEN KILGORE
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Credential |
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Telephone | 423-915-5185
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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