# BLUE RIDGE MEDICAL MANAGEMENT CORPORATION

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- **Entity:** Organization
- **Status:** 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:** 1730401209
- **Authorized official:** CARL STEVE KILGORE (PRESIDENT)
- **Authorized official phone:** (423) 302-3051

## Contact information

- **Practice address:** 2204 PAVILION DR, SUITE 310, KINGSPORT, TN 37660-4653
- **Practice address phone:** (423) 224-3900
- **Practice address fax:** (423) 224-3901
- **Mailing address:** 2204 PAVILION DR, SUITE 310, KINGSPORT, TN 37660-4653
- **Mailing address phone:** (423) 224-3900
- **Mailing address fax:** (423) 224-3901

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 02/24/2010
- **Last updated:** 03/29/2019

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1730401209 | — | VA |
| 05 | — | 3719388 | — | TN |
| 01 | — | 623293300 | DEPARTMENT OF LABOR | TN |
| 01 | — | CA5744 | RAILROAD MEDICARE | TN |