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Organization
BLUE RIDGE MEDICAL MANAGEMENT CORPORATION
Active
Organization
BLUE RIDGE MEDICAL MANAGEMENT CORPORATION
Active
Other names
MSMG FM IM JC, BHMA Family Medicine and Internal Medicine Johnson City, Ballad Health Medical Associates
Organization subpart
No
Provider details
NPI number
Authorized official
CARL STEVEN KILGORE (PRESIDENT)
(423) 302-3051
Entity
Organization
Contact information
Practice address
1021 W OAKLAND AVE, SUITE 301, JOHNSON CITY, TN 37604-2191
(423) 952-8000
(423) 952-8001
Mailing address
1021 W OAKLAND AVE, SUITE 301, JOHNSON CITY, TN 37604-2191
(423) 952-8000
(423) 952-8001
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
NULL
207Q00000X
Family Medicine Physician
Primary
—
—
313M00000X
Nursing Facility/Intermediate Care Facility
—
NULL
314000000X
Skilled Nursing Facility
—
NULL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1255341509
—
VA
05
—
3706263
—
TN
01
—
622968600
DEPARTMENT OF LABOR
TN
Enumeration date
08/09/2006
Last updated
10/01/2024
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