# BLUE RIDGE MEDICAL MANAGEMENT CORPORATION

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- **Entity:** Organization
- **Status:** Active
- **Other names:** BHMA Pediatric Urology Johnson City, MSMG Pediatric Urology Johnson City, Ballad Health Medical Associates
- **Organization subpart:** No

## Provider details

- **NPI number:** 1568958775
- **Authorized official:** CARL KILGORE (PRESIDENT)
- **Authorized official phone:** (423) 302-3051

## Contact information

- **Practice address:** 408 N STATE OF FRANKLIN RD STE 31F, JOHNSON CITY, TN 37604-6088
- **Practice address phone:** (423) 431-4946
- **Practice address fax:** (423) 431-4947
- **Mailing address:** 408 N STATE OF FRANKLIN RD STE 31F, JOHNSON CITY, TN 37604-6088
- **Mailing address phone:** (423) 431-4946
- **Mailing address fax:** (423) 431-4947

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2088P0231X | Pediatric Urology Physician | — | NULL | Yes |
| 2088P0231X | Pediatric Urology Physician | — | — | Yes |

## Other

- **Enumeration date:** 07/11/2018
- **Last updated:** 03/29/2019