Organization
BLUE RIDGE MEDICAL MANAGEMENT CORPORATION
Active
Other names
Ballad Health Medical Associates, MSMG Cardiology KPT, BHMA Heart and Vascular Care Kingsport
Organization subpart
No
Provider details
NPI number
Authorized official
C STEVEN KILGORE (SENIOR VICE PRESIDENT)
(423) 302-3051
Entity
Organization
Contact information
Practice address
2205 PAVILION DR, SUITE 201, KINGSPORT, TN 37660-4641
(423) 857-7650
(423) 857-7655
Mailing address
2205 PAVILION DR, SUITE 201, KINGSPORT, TN 37660-4641
(423) 857-7650
(423) 857-7655
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
020487806
DEPARTMENT OF LABOR
TN
05
—
1487690434
—
VA
05
—
3716299
—
TN
05
—
7100080500
—
KY
01
—
CA5744
RAILROAD MEDICARE
TN
Enumeration date
06/20/2006
Last updated
03/29/2019
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