Organization
BLUE RIDGE MEDICAL MANAGEMENT CORPORATION
Active
Other names
BHMA Gastroenterology JC, MSMG GI JC, Ballad Health Medical Associates
Organization subpart
No
Provider details
NPI number
Authorized official
CARL STEVE KILGORE (PRESIDENT)
(423) 302-3051
Entity
Organization
Contact information
Practice address
408 N STATE OF FRANKLIN RD, SUITE 24, JOHNSON CITY, TN 37604-6089
(423) 431-1810
(423) 431-1811
Mailing address
408 N STATE OF FRANKLIN RD, SUITE 24, JOHNSON CITY, TN 37604-6089
(423) 431-1810
(423) 431-1811
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
020487800
DEPARTMENT OF LABOR
TN
05
—
1134400039
—
VA
05
—
1525808
—
TN
Enumeration date
09/06/2011
Last updated
03/28/2019
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