Organization
BLUE RIDGE MEDICAL MANAGEMENT CORPORATION
Active
Other names
Ballad Health Medical Associates, MSMG HIMA JCMC, BHMA Hospitalists JCMC
Organization subpart
No
Provider details
NPI number
Authorized official
CARL STEVEN KILGORE (PRESIDENT)
(423) 302-3051
Entity
Organization
Contact information
Practice address
408 N STATE OF FRANKLIN RD, SUITE 24, JOHNSON CITY, TN 37604-6089
(423) 431-1810
(423) 431-1811
Mailing address
400 N STATE OF FRANKLIN RD, JOHNSON CITY, TN 37604-6035
(423) 431-1810
(423) 431-1811
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
—
TN
208M00000X
Hospitalist Physician
Primary
—
—
363L00000X
Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
020487819
DEPARTMENT OF LABOR
TN
05
—
1515079
—
TN
05
—
1912137506
—
VA
01
—
4344857
BLUECARE
TN
05
—
5912773
—
NC
05
—
7100104590
—
KY
05
—
7100117550
—
KY
01
—
CA5744
RR MEDICARE
TN
Enumeration date
07/17/2009
Last updated
08/07/2023
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