Organization
BLUE RIDGE MEDICAL MANAGEMENT CORPORATION
Active
Other names
MSMG Hospital Pediatrics NSCH, BHMA Pediatric Hospitalists NSCH, Ballad Health Medical Associates
Organization subpart
No
Provider details
NPI number
Authorized official
CARL STEVEN KILGORE (PRESIDENT)
(423) 302-3051
Entity
Organization
Contact information
Practice address
400 N STATE OF FRANKLIN RD, OFFICE OF NISWONGER CEO, JOHNSON CITY, TN 37604-6035
(423) 431-4847
(423) 431-3949
Mailing address
400 N STATE OF FRANKLIN RD, OFFICE OF NISWONGER CEO, JOHNSON CITY, TN 37604-6035
(423) 431-4847
(423) 431-3949
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1386028215
—
NC
05
—
1386028215
—
VA
05
—
Q013912
—
TN
Enumeration date
07/09/2015
Last updated
03/29/2019
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