| Organization Name: | BLUE RIDGE MEDICAL MANAGEMENT CORPORATION |
| NPI Number: | 1144380833 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | CARL STEVEN KILGORE (PRESIDENT) |
| Mailing Address: | 314 Rogosin Dr Elizabethton |
| State: | TN US |
| Postal Code: | 376432904 |
| Phone Number: | 4238542892 |
| Fax Number: | 4235428621 |
| NPI Enumeration Date: | 12/11/2006 |
| NPI Last Update Date: | 07/13/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QU0200X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Urgent Care |
| Taxonomy Definition: | |