# BLUE RIDGE MEDICAL MANAGEMENT CORPORATION

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- **Entity:** Organization
- **Status:** Active
- **Other names:** MSMG CVT JC, BHMA Cardiovascular and Thoracic Surgery Johnson City, Ballad Health Medical Associates
- **Organization subpart:** No

## Provider details

- **NPI number:** 1215082730
- **Authorized official:** C STEVEN KILGORE (PRESIDENT)
- **Authorized official phone:** (423) 302-3051

## Contact information

- **Practice address:** 310 N STATE OF FRANKLIN RD, SUITE 101, JOHNSON CITY, TN 37604-6008
- **Practice address phone:** (423) 929-7393
- **Practice address fax:** (423) 929-0872
- **Mailing address:** 310 N STATE OF FRANKLIN RD, SUITE 101, JOHNSON CITY, TN 37604-6008
- **Mailing address phone:** (423) 929-7393
- **Mailing address fax:** (423) 929-0872

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208G00000X | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician | — | NULL | Yes |
| 208G00000X | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician | — | — | Yes |
| 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