Organization
BLUE RIDGE MEDICAL MANAGEMENT CORPOARTION
Active
Other names
East Tennessee Brain And Spine Center an affiliate of MSMG, Ballad Health Medical Associates, BHMA Neurosurgery, Spine and Rehabilitation Kingsport, BHMA Neurosurgery, Spine and Rehabilitation Johnson City
Organization subpart
No
Provider details
NPI number
Authorized official
CARL KILGORE (PRESIDENT)
(423) 302-3051
Entity
Organization
Contact information
Practice address
701 MED TECH PKWY STE 300, JOHNSON CITY, TN 37604-2365
(423) 232-8301
(423) 232-8304
Mailing address
701 MED TECH PKWY STE 300, JOHNSON CITY, TN 37604-2365
(423) 232-8301
(423) 232-8304
Taxonomy
Speciality
Code
Description
License number
State
207T00000X
Neurological Surgery Physician
Primary
—
—
363A00000X
Physician Assistant
—
—
363AS0400X
Surgical Physician Assistant
—
—
363LA2200X
Adult Health Nurse Practitioner
—
—
363LF0000X
Family Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
Q035119
—
TN
Enumeration date
03/30/2018
Last updated
03/29/2019
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