Organization
BLUE RIDGE MEDICAL MANAGEMENT CORPORATION
Active
Other names
MSMG NEUROSURG JC, Ballad Health Medical Associates, BHMA Neurosurgery and Spine JC
Organization subpart
No
Provider details
NPI number
Authorized official
CARL STEVEN KILGORE (PRESIDENT / CEO)
(423) 302-3051
Entity
Organization
Contact information
Practice address
410 N STATE OF FRANKLIN RD, SUITE 120, JOHNSON CITY, TN 37604-6971
(423) 431-2350
(423) 431-2372
Mailing address
410 N STATE OF FRANKLIN RD, SUITE 120, JOHNSON CITY, TN 37604-6971
(423) 431-2350
(423) 431-2372
Taxonomy
Speciality
Code
Description
License number
State
207T00000X
Neurological Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
020487821
DEPARTMENT OF LABOR/BLACK LUNG & ENERGY
TN
05
—
1003152370
—
VA
05
—
Q002409
—
TN
Enumeration date
12/14/2012
Last updated
03/28/2019
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