# BLUE RIDGE MEDICAL MANAGEMENT CORPORATION

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- **Entity:** Organization
- **Status:** 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:** 1255341509
- **Authorized official:** CARL STEVEN KILGORE (PRESIDENT)
- **Authorized official phone:** (423) 302-3051

## Contact information

- **Practice address:** 1021 W OAKLAND AVE, SUITE 301, JOHNSON CITY, TN 37604-2191
- **Practice address phone:** (423) 952-8000
- **Practice address fax:** (423) 952-8001
- **Mailing address:** 1021 W OAKLAND AVE, SUITE 301, JOHNSON CITY, TN 37604-2191
- **Mailing address phone:** (423) 952-8000
- **Mailing address fax:** (423) 952-8001

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |
| 313M00000X | Nursing Facility/Intermediate Care Facility | — | NULL | — |
| 314000000X | Skilled Nursing Facility | — | NULL | — |

## Other

- **Enumeration date:** 08/09/2006
- **Last updated:** 10/01/2024

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1255341509 | — | VA |
| 05 | — | 3706263 | — | TN |
| 01 | — | 622968600 | DEPARTMENT OF LABOR | TN |