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General NPI Number Information
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NPI Number | 1447543996
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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 | 05/17/2011
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Last Update Date | 05/02/2025
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Provider Practice Location Address
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Address Line | 7021 WEST LEE HIGHWAY SUITE C
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City | RURAL RETREAT
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State | VA
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Zip | 24368
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Country | US
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Telephone | 866-595-3662
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Fax | 276-686-6046
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Provider Business Mailing Address
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Address Line | 7021 WEST LEE HIGHWAY SUITE C
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City | RURAL RETREAT
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State | VA
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Zip | 24368
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Country | US
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Telephone | 866-595-3662
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Fax | 276-686-6046
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. CARL STEVEN 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 | 207Q00000X
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Taxonomy Name | Family Medicine 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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