Organization
BLUE RIDGE MEDICAL MANAGEMENT CORPORATION
Active
Other names
BHMA Family Medicine and Internal Medicine Elizabethton, MSMG FP IM ELIZ, 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
1505 W ELK AVE, SUITE 2, ELIZABETHTON, TN 37643-2848
(423) 543-1261
(423) 543-7500
Mailing address
1505 W ELK AVE, SUITE 2, ELIZABETHTON, TN 37643-2848
(423) 543-1261
(423) 543-7500
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
207R00000X
Internal Medicine Physician
—
—
207SG0205X
Ph.D. Medical Genetics Physician
—
—
363A00000X
Physician Assistant
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
020487807
DEPARTMENT OF LABOR
TN
05
—
1532240
—
TN
01
—
CA5744
RR MEDICARE
TN
Enumeration date
03/22/2013
Last updated
03/29/2019
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