| Organization Name: | BLUE RIDGE MEDICAL MANAGEMENT |
| NPI Number: | 1063819720 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | CARL STEPHEN KILGORE (PRESIDENT) |
| Mailing Address: | 98 15th St Nw Suite 201 B Norton |
| State: | VA US |
| Postal Code: | 242731600 |
| Phone Number: | 2764391490 |
| Fax Number: | 2764391495 |
| NPI Enumeration Date: | 11/24/2014 |
| NPI Last Update Date: | 03/04/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 2086S0129X |
| License Number: | 0101254593 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | VA |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Surgery |
| Taxonomy Specialization: | Vascular Surgery |
| Taxonomy Definition: | A surgeon with expertise in the management of surgical disorders of the blood vessels, excluding the intracranial vessels or the heart. |