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General NPI Number Information
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NPI Number | 1699943951
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Entity Type | Organization
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Legal Business Name | BLUE RIDGE MEDICAL MANGEMENT CORPORATION
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Dates
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Enumeration Date | 02/20/2008
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Last Update Date | 02/20/2008
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Provider Practice Location Address
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Address Line | 81 CARROLL STREET
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City | LEBANON
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State | VA
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Zip | 24266
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Country | US
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Telephone | 276-883-8085
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Fax | 276-883-8090
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Provider Business Mailing Address
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Address Line | PO BOX 3600
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City | LEBANON
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State | VA
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Zip | 24266-0200
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Country | US
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Telephone | 276-883-8471
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Fax | 276-883-8475
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Authorized Official
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Title or Position | 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 | 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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