Organization
BLUE RIDGE MEDICAL MANAGEMENT CORPORATION
Active
Other names
Ballad Health Medical Associates, MSMG Pediatric Critical Care, BHMA Pediatric Critical Care Johnson City
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CARL STEVE KILGORE (PRESIDENT)
(423) 302-3051
Entity
Organization
Contact information
Practice address
408 N STATE OF FRANKLIN RD, SUITE 31D, JOHNSON CITY, TN 37604-6089
(423) 431-4946
(423) 431-4947
Mailing address
408 N STATE OF FRANKLIN RD, SUITE 31D, JOHNSON CITY, TN 37604-6089
(423) 431-4946
(423) 431-4947
Taxonomy
Speciality
Code
Description
License number
State
2080P0203X
Pediatric Critical Care Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1811378854
—
VA
05
—
Q013694
—
TN
Enumeration date
06/16/2015
Last updated
03/29/2019
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