Organization
BLUE RIDGE MEDICAL MANAGEMENT CORPORATION
Active
Other names
MSMG CVT JC, BHMA Cardiovascular and Thoracic Surgery Johnson City, Ballad Health Medical Associates
Organization subpart
No
Provider details
NPI number
Authorized official
C STEVEN KILGORE (PRESIDENT)
(423) 302-3051
Entity
Organization
Contact information
Practice address
310 N STATE OF FRANKLIN RD, SUITE 101, JOHNSON CITY, TN 37604-6008
(423) 929-7393
(423) 929-0872
Mailing address
310 N STATE OF FRANKLIN RD, SUITE 101, JOHNSON CITY, TN 37604-6008
(423) 929-7393
(423) 929-0872
Taxonomy
Speciality
Code
Description
License number
State
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
Primary
—
—
363A00000X
Physician Assistant
—
—
363AS0400X
Surgical Physician Assistant
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
020487811
DEPARTMENT OF LABOR/FECA
TN
05
—
1215082730
—
VA
05
—
3732723
—
TN
05
—
7100008280
—
KY
05
—
7100170580
—
KY
01
—
DF7910
RAILROAD MEDICARE
TN
Enumeration date
01/24/2007
Last updated
03/29/2019
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