Provider Demographics
NPI:1336442649
Name:BLUE RIDGE MEDICAL MANAGEMENT CORPOARTION
Entity Type:Organization
Organization Name:BLUE RIDGE MEDICAL MANAGEMENT CORPOARTION
Other - Org Name:MSMG ORTHO ELIZ
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CARL
Authorized Official - Middle Name:S
Authorized Official - Last Name:KILGORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-915-5100
Mailing Address - Street 1:1497 WEST ELK AVE
Mailing Address - Street 2:SUITE 11
Mailing Address - City:ELIZABETHTON
Mailing Address - State:TN
Mailing Address - Zip Code:37643
Mailing Address - Country:US
Mailing Address - Phone:423-542-7480
Mailing Address - Fax:423-542-7485
Practice Address - Street 1:1497 WEST ELK AVE
Practice Address - Street 2:SUITE 11
Practice Address - City:ELIZABETHTON
Practice Address - State:TN
Practice Address - Zip Code:37643
Practice Address - Country:US
Practice Address - Phone:423-542-7480
Practice Address - Fax:423-542-7485
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-08
Last Update Date:2011-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty