| Organization Name: | BLUE RIDGE MEDICAL MANAGEMENT CORPORATION |
| NPI Number: | 1659475374 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | C. STEVEN KILGORE (SENIOR VICE PRESIDENT) |
| Mailing Address: | 2300 Pavilion Dr Kingsport |
| State: | TN US |
| Postal Code: | 376604622 |
| Phone Number: | 4233925500 |
| Fax Number: | 4233925597 |
| NPI Enumeration Date: | 09/12/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 2084A0401X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | X |
| State: | |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Psychiatry & Neurology |
| Taxonomy Specialization: | Addiction Medicine |
| Taxonomy Definition: | A doctor of osteopathy board eligible/certified in the field of Psychiatry by the American Osteopathic Board of Neurology and Psychiatry is able to obtain a Certificate of Added Qualifications in the field of Addiction Medicine |