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General NPI Number Information
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NPI Number | 1982882379
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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 | 02/07/2008
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Last Update Date | 07/13/2010
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Provider Practice Location Address
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Address Line | 1101 E STONE DR SUITE 2
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City | KINGSPORT
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State | TN
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Zip | 37660-3384
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Country | US
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Telephone | 423-246-7259
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Fax | 423-246-7205
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Provider Business Mailing Address
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Address Line | 1101 E STONE DR SUITE 2
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City | KINGSPORT
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State | TN
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Zip | 37660-3384
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Country | US
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Telephone | 423-246-7259
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Fax | 423-246-7205
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Authorized Official
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Title or Position | PRESIDENT
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Name | CARL STEVEN KILGORE
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Credential |
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Telephone | 423-915-5234
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number |
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License Number State |
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