Organization
BLUE RIDGE MEDICAL MANAGEMENT CORPORATION
Active
Other names
Ballad Health Medical Associates, BHMA Hospitalists SCCH, MSMG HIMA SCCH
Organization subpart
No
Provider details
NPI number
Authorized official
CARL STEVEN KILGORE (PRESIDENT)
(423) 302-3051
Entity
Organization
Contact information
Practice address
245 MEDICAL PARK DR, FIRST FLOOR, MARION, VA 24354-1100
(276) 378-1341
(276) 378-1205
Mailing address
245 MEDICAL PARK DR, FIRST FLOOR, MARION, VA 24354-1100
(276) 378-1341
(276) 378-1205
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
—
—
208M00000X
Hospitalist Physician
Primary
—
—
363A00000X
Physician Assistant
—
—
363L00000X
Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1639463490
—
VA
01
—
622799700
DEPARTMENT OF LABOR
VA
01
—
DT9105
RAILROAD MEDICARE
VA
05
—
Q002125
—
TN
Enumeration date
06/08/2011
Last updated
03/29/2019
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