Provider Demographics
NPI:1972915759
Name:NOLICHUCKEY MANAGEMENT SERVICES, INC
Entity Type:Organization
Organization Name:NOLICHUCKEY MANAGEMENT SERVICES, INC
Other - Org Name:BALLAD HEALTH MEDICAL ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:COMPTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-783-5512
Mailing Address - Street 1:2020 BROOKSIDE DR
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37660-4633
Mailing Address - Country:US
Mailing Address - Phone:423-343-0434
Mailing Address - Fax:423-343-0435
Practice Address - Street 1:1406 TUSCULUM BLVD
Practice Address - Street 2:SUITE 1200 A
Practice Address - City:GREENEVILLE
Practice Address - State:TN
Practice Address - Zip Code:37745-4332
Practice Address - Country:US
Practice Address - Phone:423-783-5512
Practice Address - Fax:423-783-5515
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-28
Last Update Date:2019-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty