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Organization
BLUE RIDGE MEDICAL MANAGEMENT CORPORATION
Active
Organization
BLUE RIDGE MEDICAL MANAGEMENT CORPORATION
Active
Other names
BHMA Family Medicine, Internal Medicine and Pediatrics Kingsport, Ballad Health Medical Associates, MSMG FP IM PEDS KPT
Organization subpart
No
Provider details
NPI number
Authorized official
CARL STEVE KILGORE (PRESIDENT)
(423) 302-3051
Entity
Organization
Contact information
Practice address
2204 PAVILION DR, SUITE 310, KINGSPORT, TN 37660-4653
(423) 224-3900
(423) 224-3901
Mailing address
2204 PAVILION DR, SUITE 310, KINGSPORT, TN 37660-4653
(423) 224-3900
(423) 224-3901
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
05
—
1730401209
—
VA
05
—
3719388
—
TN
01
—
623293300
DEPARTMENT OF LABOR
TN
01
—
CA5744
RAILROAD MEDICARE
TN
Enumeration date
02/24/2010
Last updated
03/29/2019
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