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Organization
BLUE RIDGE MEDICAL MANAGEMENT CORPORATION
Active
Organization
BLUE RIDGE MEDICAL MANAGEMENT CORPORATION
Active
Other names
MSMG FP ELIZ, Ballad Health Medical Associates, BHMA Family Medicine Elizabethton
Organization subpart
No
Provider details
NPI number
Authorized official
CARL S KILGORE (PRESIDENT)
(423) 302-3051
Entity
Organization
Contact information
Practice address
1497 WEST ELK AVE, SUITE 21, ELIZABETHTON, TN 37643
(423) 542-7420
(423) 542-7425
Mailing address
1497 WEST ELK AVE, SUITE 21, ELIZABETHTON, TN 37643
(423) 542-7420
(423) 542-7425
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
NULL
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
020487839
DEPARTMENT OF LABOR
TN
05
—
1255634564
—
VA
05
—
1526580
—
TN
Enumeration date
12/08/2010
Last updated
03/29/2019
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