Organization
BLUE RIDGE MEDICAL MANAGEMENT CORPORATION
Active
Other names
MSMG CARDIOLOGY ERWIN, BHMA Heart and Vascular Care Erwin, Ballad Health Medical Associates
Organization subpart
No
Provider details
NPI number
Authorized official
CARL STEVEN KILGORE (PRESIDENT / CEO)
(423) 302-3051
Entity
Organization
Contact information
Practice address
800 S MOHAWK DR, SUITE C, ERWIN, TN 37650-2124
(423) 979-6000
(423) 979-6011
Mailing address
800 S MOHAWK DR, SUITE C, ERWIN, TN 37650-2124
(423) 979-6000
(423) 979-6011
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1205253770
—
VA
01
—
CA5744
RAILROAD MEDICARE
TN
05
—
Q005538
—
TN
Enumeration date
03/24/2014
Last updated
03/29/2019
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