Basic Information
| Provider Information | |||||||||
| NPI: | 1528357472 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NOLICHUCKEY MANAGEMENT SERVICES, INC | ||||||||
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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: | 1406 TUSCULUM BLVD | ||||||||
| Address2: | SUITE 1000 | ||||||||
| City: | GREENEVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 377454332 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4237835510 | ||||||||
| FaxNumber: | 4237835515 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/31/2011 | ||||||||
| LastUpdateDate: | 10/28/2019 | ||||||||
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| AuthorizedOfficialLastName: | COMPTON | ||||||||
| AuthorizedOfficialFirstName: | MARK | ||||||||
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| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 4237875021 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
No ID Information.