Organization
BLUE RIDGE MEDICAL MANAGEMENT CORPORATION
Active
Other names
Cardiology Consultants of Johnson City
Organization subpart
No
Provider details
NPI number
Authorized official
CARL S KILGORE (PRESIDENT)
(423) 915-5100
Entity
Organization
Contact information
Practice address
311 PRINCETON RD, SUITE 7, JOHNSON CITY, TN 37601-2026
(423) 282-3236
(423) 283-4746
Mailing address
311 PRINCETON RD, SUITE 7, JOHNSON CITY, TN 37601-2026
(423) 282-3236
(423) 283-9430
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
—
—
363L00000X
Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
02571
BLUE CROSS OF NC
NC
05
—
3702646
—
TN
05
—
890117J
—
NC
01
—
CD7031
RAIL ROAD MEDICARE
—
Enumeration date
07/07/2006
Last updated
02/14/2013
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