Basic Information
| Provider Information | |||||||||
| NPI: | 1356611305 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NOLICHUCKEY MANAGEMENT SERVICES, INC. | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | BALLAD HEALTH MEDICAL ASSOCIATES | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2020 BROOKSIDE DR | ||||||||
| Address2: | |||||||||
| City: | KINGSPORT | ||||||||
| State: | TN | ||||||||
| PostalCode: | 376604633 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4233430434 | ||||||||
| FaxNumber: | 4233430435 | ||||||||
| Practice Location | |||||||||
| Address1: | 1410 TUSCULUM BLVD | ||||||||
| Address2: | SUITE 1700 | ||||||||
| City: | GREENEVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 377454286 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4237877100 | ||||||||
| FaxNumber: | 4237877109 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/09/2012 | ||||||||
| LastUpdateDate: | 11/19/2020 | ||||||||
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| AuthorizedOfficialLastName: | COMPTON | ||||||||
| AuthorizedOfficialFirstName: | JOHN | ||||||||
| AuthorizedOfficialMiddleName: | MARK | ||||||||
| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 4237875077 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| NPICertificationDate: | 11/19/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Surgery |
No ID Information.