Organization
BLUE RIDGE MEDICAL MANAGEMENT CORPORATION
Active
Other names
BHMA Pediatric Endocrinology Johnson City, Ballad Health Medical Associates, MSMG Pedicatric Endocrinology
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 31B, JOHNSON CITY, TN 37604-6089
(423) 431-4946
(423) 431-4947
Mailing address
408 N STATE OF FRANKLIN RD, SUITE 31B, JOHNSON CITY, TN 37604-6089
(423) 431-4946
(423) 431-4947
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
207RE0101X
Endocrinology, Diabetes & Metabolism Physician
—
—
2080P0205X
Pediatric Endocrinology Physician
—
—
363LF0000X
Family Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1962883678
—
VA
05
—
Q013929
—
TN
Enumeration date
06/18/2015
Last updated
05/02/2025
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