Organization
BLUE RIDGE MEDICAL MANAGEMENT CORPOARTION
Active
Other names
BHMA Heart and Vascular Care Lebanon, Ballad Health Medical Associates, MSMG Cardiology LEB
Organization subpart
No
Provider details
NPI number
Authorized official
CARL S KILGORE (PRESIDENT)
(423) 302-3051
Entity
Organization
Contact information
Practice address
619 W MAIN ST, LEBANON, VA 24266-3809
(276) 258-3740
(276) 258-3745
Mailing address
619 W MAIN ST, LEBANON, VA 24266-3809
(276) 258-3740
(276) 258-3745
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1548562267
—
VA
01
—
622678800
DEPARTMENT OF LABOR
VA
Enumeration date
12/01/2010
Last updated
03/29/2019
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