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General NPI Number Information
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NPI Number | 1376846683
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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 | 12/08/2010
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Last Update Date | 05/02/2025
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Provider Practice Location Address
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Address Line | 1497 WEST ELK AVE STE 10
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City | ELIZABETHTON
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State | TN
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Zip | 37643
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Country | US
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Telephone | 423-542-7440
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Fax | 423-542-7445
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Provider Business Mailing Address
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Address Line | 1497 WEST ELK AVE STE 10
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City | ELIZABETHTON
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State | TN
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Zip | 37643
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Country | US
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Telephone | 423-542-7440
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Fax | 423-542-7445
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Authorized Official
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Title or Position | PRESIDENT
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Name | CARL S KILGORE
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Credential |
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Telephone | 423-302-3051
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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