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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