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General NPI Number Information
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NPI Number | 1538315452
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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 | 08/12/2008
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Last Update Date | 09/07/2010
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Provider Practice Location Address
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Address Line | 2020 BROOKSIDE DRIVE SUITE 20
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City | KINGSPORT
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State | TN
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Zip | 37660-4633
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Country | US
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Telephone | 423-392-4673
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Fax | 423-932-4257
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Provider Business Mailing Address
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Address Line | 2020 BROOKSIDE DRIVE SUITE 20
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City | KINGSPORT
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State | TN
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Zip | 37660-4633
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Country | US
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Telephone | 423-392-4673
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Fax | 423-932-4257
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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 | 423-915-5121
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RH0003X
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Taxonomy Name | Hematology & Oncology 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 | 207RX0202X
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Taxonomy Name | Medical Oncology Physician
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License Number |
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License Number State |
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