Organization
BLUE RIDGE MEDICAL MANAGEMENT CORPORATION
Active
Organization
BLUE RIDGE MEDICAL MANAGEMENT CORPORATION
Active
Other names
BHMA Neuroendovascular Surgery Johnson City, MSMG Neuroendovascular Johnson City, Ballad Health Medical Associates, BHMA Interventional Radiology - Johnson City
Organization subpart
No
Provider details
NPI number
Authorized official
CARL STEVEN KILGORE (PRESIDENT)
(423) 302-3051
Entity
Organization
Contact information
Practice address
410 N STATE OF FRANKLIN RD, SUITE 135B, JOHNSON CITY, TN 37604
(423) 431-4866
(423) 431-2372
Mailing address
410 N STATE OF FRANKLIN RD, SUITE 135B, JOHNSON CITY, TN 37604
(423) 431-4866
(423) 431-2372
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
2085R0204X
Vascular & Interventional Radiology Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1043688385
—
VA
01
—
622480000
DEPARTMENT OF LABOR
TN
01
—
CA5744
RAILROAD MEDICARE
TN
05
—
Q014763
—
TN
Enumeration date
09/03/2015
Last updated
05/02/2025
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