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Organization
BLUE RIDGE MEDICAL MANAGEMENT CORPORATION
Active
Organization
BLUE RIDGE MEDICAL MANAGEMENT CORPORATION
Active
Other names
MSMG CVT JC, BHMA Cardiovascular and Thoracic Surgery Johnson City, Ballad Health Medical Associates
Organization subpart
No
Provider details
NPI number
Authorized official
C STEVEN KILGORE (PRESIDENT)
(423) 302-3051
Entity
Organization
Contact information
Practice address
310 N STATE OF FRANKLIN RD, SUITE 101, JOHNSON CITY, TN 37604-6008
(423) 929-7393
(423) 929-0872
Mailing address
310 N STATE OF FRANKLIN RD, SUITE 101, JOHNSON CITY, TN 37604-6008
(423) 929-7393
(423) 929-0872
Taxonomy
Speciality
Code
Description
License number
State
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
Primary
—
NULL
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
Primary
—
—
363A00000X
Physician Assistant
—
NULL
363A00000X
Physician Assistant
—
—
363AS0400X
Surgical Physician Assistant
—
NULL
363AS0400X
Surgical Physician Assistant
—
—
Other
Enumeration date
01/24/2007
Last updated
03/29/2019
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