Provider Demographics
NPI:1063920577
Name:BLUE RIDGE MEDICAL MANAGEMENT CORPOARTION
Entity type:Organization
Organization Name:BLUE RIDGE MEDICAL MANAGEMENT CORPOARTION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CARL
Authorized Official - Middle Name:
Authorized Official - Last Name:KILGORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-302-3051
Mailing Address - Street 1:325 BRUNSWICK LN
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:VA
Mailing Address - Zip Code:24354-3903
Mailing Address - Country:US
Mailing Address - Phone:276-783-9687
Mailing Address - Fax:276-783-1310
Practice Address - Street 1:325 BRUNSWICK LN
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:VA
Practice Address - Zip Code:24354-3903
Practice Address - Country:US
Practice Address - Phone:276-783-9687
Practice Address - Fax:276-783-1310
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-18
Last Update Date:2025-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational Medicine
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty