Organization
BLUE RIDGE MEDICAL MANAGEMENT CORPORATION
Active
Other names
Ballad Health Medical Associates, BHMA Hematology and Oncology Johnson City, Regional Cancer Center at Johnson City Medical Center
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CARL STEVEN KILGORE (PRESIDENT/CEO)
(423) 302-3051
Entity
Organization
Contact information
Practice address
1 PROFESSIONAL PARK DR, STE 21, JOHNSON CITY, TN 37604-6587
(423) 232-6900
(423) 232-6903
Mailing address
1 PROFESSIONAL PARK DR, STE 21, JOHNSON CITY, TN 37604-6587
(423) 232-6900
(423) 232-6903
Taxonomy
Speciality
Code
Description
License number
State
207RX0202X
Medical Oncology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
020487822
DEPARTMENT OF LABOR
TN
05
—
1275761538
—
VA
05
—
1516423
—
TN
01
—
CA5744
RAILROAD MEDICARE
TN
Enumeration date
06/25/2009
Last updated
03/29/2019
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