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BLUE RIDGE MEDICAL MANAGEMENT CORPORATION NPI 1093016024


NPI Information

NPI: 1093016024
Provider Name: BLUE RIDGE MEDICAL MANAGEMENT CORPORATION

Doing Business As: BALLAD HEALTH MEDICAL ASSOCIATES

Classification: Surgery - 2086S0127X
Entity Type: Organization

Specialization: Trauma Surgery

Address:
410 N STATE OF FRANKLIN RD
SUITE 130
JOHNSON CITY, TN
ZIP 37604
Phone: (423) 431-2477
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BLUE RIDGE MEDICAL MANAGEMENT CORPORATION is a trauma surgery surgery in Johnson City, TN. The provider is trauma surgery is a recognized subspecialty of general surgery. Trauma surgeons are physicians who have completed a five-year general surgery residency and usually continue with a one to two year fellowship in trauma and/or surgical critical care, typically leading to additional board certification in surgical critical care. There is no trauma surgery board certification at this point. To obtain board certification in surgical critical care, a fellowship in surgical critical care or anesthesiology critical care must be completed during or after general surgery residency. BLUE RIDGE MEDICAL MANAGEMENT CORPORATION NPI is 1093016024. The provider is registered as an organization entity type and is a multi-specialty group.
The provider Is Doing Business As Ballad Health Medical Associates.

The provider's business location address is:

410 N STATE OF FRANKLIN RD
SUITE 130
JOHNSON CITY, TN
ZIP 37604-971
Phone: (423) 431-2477
Fax: (423) 431-2478

The provider's authorized official is Carl S Kilgore .
The authorized official title is President/ceo and has the following contact phone number (423) 302-3051.

The enumeration date for this NPI number is 11/8/2010 and was last updated on 3/28/2019.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1207XX0801XOrthopaedic SurgeryOrthopaedic TraumaNo
2208600000XSurgeryNo
32086S0127XSurgeryTrauma SurgeryYes
4363AS0400XPhysician AssistantSurgicalNo
5363L00000XNurse PractitionerNo

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1020487825OTHERTENNESSEEDEPARTMENT OF LABOR
21093016024MEDICAIDVIRGINIA
35917230MEDICAIDNORTH CAROLINA
4CA5744OTHERTENNESSEERAIL ROAD MEDICARE
57100203970MEDICAIDKENTUCKY
61522339MEDICAIDTENNESSEE
77100163800MEDICAIDKENTUCKY

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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