Organization
BLUE RIDGE MEDICAL MANAGEMENT CORPORATION
Active
Other names
Ballad Health Medical Associates, MSMG Structural Heart Clinic JC, BHMA Structural Heart Clinic JC
Organization subpart
No
Provider details
NPI number
Authorized official
CARL STEVEN KILGORE (PRESIDENT/CEO)
(423) 302-3051
Entity
Organization
Contact information
Practice address
400 N STATE OF FRANKLIN RD, ROOM LK015, JOHNSON CITY, TN 37604
(423) 431-5965
(423) 431-3572
Mailing address
400 N STATE OF FRANKLIN RD, ROOM LK015, JOHNSON CITY, TN 37604-6035
(423) 431-5965
(423) 431-3572
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1003273251
—
VA
05
—
Q019338
—
TN
Enumeration date
01/19/2016
Last updated
03/28/2019
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