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BLUE RIDGE MEDICAL MANAGEMENT CORPORATION NPI 1962883678


NPI Information

NPI: 1962883678
Provider Name: BLUE RIDGE MEDICAL MANAGEMENT CORPORATION

Doing Business As: BALLAD HEALTH MEDICAL ASSOCIATES

Classification: Pediatrics - 2080P0205X
Entity Type: Organization

Specialization: Pediatric Endocrinology

Address:
408 N STATE OF FRANKLIN RD
SUITE 31B
JOHNSON CITY, TN
ZIP 37604
Phone: (423) 431-4946
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BLUE RIDGE MEDICAL MANAGEMENT CORPORATION is a pediatric endocrinology pediatrics in Johnson City, TN. The provider is a pediatrician who provides expert care to infants, children and adolescents who have diseases that result from an abnormality in the endocrine glands (glands which secrete hormones). These diseases include diabetes mellitus, growth failure, unusual size for age, early or late pubertal development, birth defects, the genital region and disorders of the thyroid, the adrenal and pituitary glands. BLUE RIDGE MEDICAL MANAGEMENT CORPORATION NPI is 1962883678. The provider is registered as an organization entity type and is a single specialty group.
The provider Is Doing Business As Ballad Health Medical Associates.

The provider's business location address is:

408 N STATE OF FRANKLIN RD
SUITE 31B
JOHNSON CITY, TN
ZIP 37604-089
Phone: (423) 431-4946
Fax: (423) 431-4947

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

The enumeration date for this NPI number is 6/18/2015 and was last updated on 3/29/2019.


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
12080P0205XPediatricsPediatric EndocrinologyYes
2363LF0000XNurse PractitionerFamilyNo

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
11962883678MEDICAIDVIRGINIA
2Q013929MEDICAIDTENNESSEE

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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