Organization
BLUE RIDGE MEDICAL MANAGEMENT CORPORATION
Active
Other names
MSMG Pulmonology of Kingsport, Ballad Health Medical Associates, BHMA Pulmonology and Sleep Medicine Kpt
Organization subpart
No
Provider details
NPI number
Authorized official
CARL STEVEN KILGORE (PRESIDENT)
(423) 302-3051
Entity
Organization
Contact information
Practice address
2205 PAVILION DR, SUITE 201B, KINGSPORT, TN 37660-4641
(423) 857-7650
(423) 857-7655
Mailing address
2205 PAVILION DR, SUITE 201B, KINGSPORT, TN 37660-4641
(423) 857-7650
(423) 857-7655
Taxonomy
Speciality
Code
Description
License number
State
207RP1001X
Pulmonary Disease Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
020487837
DEPARTMENT OF LABOR
TN
05
—
1164794525
—
VA
05
—
1528656
—
TN
Enumeration date
02/01/2012
Last updated
03/28/2019
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