Organization
BLUE RIDGE MEDICAL MANAGEMENT CORPORATION
Active
Other names
BHMA Heart and Vascular Care Johnson City, Ballad Health Medical Associates, MSMG CARDIOLOGY JC
Organization subpart
No
Provider details
NPI number
Authorized official
CARL STEVEN KILGORE (PRESIDENT)
(423) 302-3051
Entity
Organization
Contact information
Practice address
310 N STATE OF FRANKLIN RD, SUITE 400, JOHNSON CITY, TN 37604-6008
(423) 979-6000
(423) 979-6011
Mailing address
310 N STATE OF FRANKLIN RD, SUITE 400, JOHNSON CITY, TN 37604-6008
(423) 979-6000
(423) 979-6011
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
—
—
363A00000X
Physician Assistant
—
—
363LA2100X
Acute Care Nurse Practitioner
—
—
363LF0000X
Family Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
020487820
DEPARTMENT OF LABOR
TN
05
—
1740227131
—
NC
05
—
1740227131
—
VA
05
—
3377130
—
TN
01
—
CA5744
RAILROAD MEDICARE
TN
Enumeration date
06/02/2006
Last updated
03/29/2019
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