Organization
BLUE RIDGE MEDICAL MANAGEMENT CORPORATION
Active
Other names
MSMG DIABETES WOUND CARE, BHMA Wound Care JMH, 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
16000 JOHNSTON MEMORIAL DR, SUITE 313, ABINGDON, VA 24211-7664
(276) 258-3780
(276) 258-3776
Mailing address
16000 JOHNSTON MEMORIAL DR, SUITE 313, ABINGDON, VA 24211-7664
(276) 258-3780
(276) 258-3776
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
0101052144
VA
363LG0600X
Gerontology Nurse Practitioner
0024166234
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1527119
—
TN
05
—
1619263068
—
VA
01
—
622377200
DEPARTMENT OF LABOR
VA
Enumeration date
06/23/2011
Last updated
03/29/2019
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