Organization
BLUE RIDGE MEDICAL MANAGEMENT CORPORATION
Active
Other names
MSMG Trauma JC, BHMA Trauma Services Johnson City, Ballad Health Medical Associates
Organization subpart
No
Provider details
NPI number
Authorized official
CARL S KILGORE (PRESIDENT/CEO)
(423) 302-3051
Entity
Organization
Contact information
Practice address
410 N STATE OF FRANKLIN RD, SUITE 130, JOHNSON CITY, TN 37604-6971
(423) 431-2477
(423) 431-2478
Mailing address
410 N STATE OF FRANKLIN RD, SUITE 130, JOHNSON CITY, TN 37604-6971
(423) 431-2477
(423) 431-2478
Taxonomy
Speciality
Code
Description
License number
State
207XX0801X
Orthopaedic Trauma Physician
—
—
208600000X
Surgery Physician
—
—
2086S0127X
Trauma Surgery Physician
Primary
—
—
363AS0400X
Surgical Physician Assistant
—
—
363L00000X
Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
020487825
DEPARTMENT OF LABOR
TN
05
—
1093016024
—
VA
05
—
1522339
—
TN
05
—
5917230
—
NC
05
—
7100163800
—
KY
05
—
7100203970
—
KY
01
—
CA5744
RAIL ROAD MEDICARE
TN
Enumeration date
11/08/2010
Last updated
03/28/2019
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