Organization
BLUE RIDGE MEDICAL MANAGEMENT CORPORATION
Active
Other names
MSMG Cardiology ELIZ, Ballad Health Medical Associates, BHMA Heart and Vascular Care Elizabethton
Organization subpart
No
Provider details
NPI number
Authorized official
CARL S KILGORE (ENROLLMENT)
(423) 302-3051
Entity
Organization
Contact information
Practice address
1497 W ELK AVE STE 22A, ELIZABETHTON, TN 37643-2896
(423) 547-3380
(423) 547-0577
Mailing address
1497 W ELK AVE STE 22A, ELIZABETHTON, TN 37643-2896
(423) 547-3380
(423) 547-0577
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1526033
—
TN
05
—
1609179910
—
VA
01
—
622377100
DEPARTMENT OF LABOR
TN
Enumeration date
12/08/2010
Last updated
03/29/2019
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