# BLUE RIDGE MEDICAL MANAGEMENT CORPORATION

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Other names:** BHMA Family Medicine and Internal Medicine Elizabethton, MSMG FP IM ELIZ, Ballad Health Medical Associates
- **Organization subpart:** No

## Provider details

- **NPI number:** 1457693996
- **Authorized official:** CARL STEVEN KILGORE (PRESIDENT)
- **Authorized official phone:** (423) 302-3051

## Contact information

- **Practice address:** 1505 W ELK AVE, SUITE 2, ELIZABETHTON, TN 37643-2848
- **Practice address phone:** (423) 543-1261
- **Practice address fax:** (423) 543-7500
- **Mailing address:** 1505 W ELK AVE, SUITE 2, ELIZABETHTON, TN 37643-2848
- **Mailing address phone:** (423) 543-1261
- **Mailing address fax:** (423) 543-7500

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |
| 207R00000X | Internal Medicine Physician | — | NULL | — |
| 207R00000X | Internal Medicine Physician | — | — | — |
| 207SG0205X | Ph.D. Medical Genetics Physician | — | NULL | — |
| 207SG0205X | Ph.D. Medical Genetics Physician | — | — | — |
| 363A00000X | Physician Assistant | — | NULL | — |
| 363A00000X | Physician Assistant | — | — | — |

## Other

- **Enumeration date:** 03/22/2013
- **Last updated:** 03/29/2019

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 020487807 | DEPARTMENT OF LABOR | TN |
| 05 | — | 1532240 | — | TN |
| 01 | — | CA5744 | RR MEDICARE | TN |