Organization Name: | KINGSPORT PRIMARY CARE, PC |
NPI Number: | 1023186145 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | GINGER D REECE (PRACTICE MANAGER) |
Mailing Address: | 1526 Bridgewater Ln Kingsport |
State: | TN US |
Postal Code: | 376604106 |
Phone Number: | 4232460033 |
Fax Number: | 4232450034 |
NPI Enumeration Date: | 11/30/2006 |
NPI Last Update Date: | 06/29/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QP2300X |
License Number: | MD11895 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | TN |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Primary Care |
Taxonomy Definition: |