Organization
BLUE RIDGE MEDICAL MANAGEMENT CORPORATION
Active
Other names
MSMG NEUROLOGY JC, BHMA Neurohospitalists Johnson City, Ballad Health Medical Associates
Organization subpart
No
Provider details
NPI number
Authorized official
CARL STEVEN KILGORE (PRESIDENT / CEO)
(423) 302-3051
Entity
Organization
Contact information
Practice address
410 N STATE OF FRANKLIN RD, SUITE 135, JOHNSON CITY, TN 37604-6971
(423) 431-2350
(423) 431-2372
Mailing address
410 N STATE OF FRANKLIN RD, SUITE 135, JOHNSON CITY, TN 37604-6971
(423) 431-2350
(423) 431-2372
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1659776375
—
VA
01
—
CA5744
RR MEDICARE
TN
05
—
Q010028
—
TN
Enumeration date
10/23/2014
Last updated
03/29/2019
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