| Organization Name: | KINGSPORT AMBULATORY SURGERY CTR |
| NPI Number: | 1053404574 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | LYNN KRUTAK (SVP/CFO) |
| Mailing Address: | 2204 Pavilion Drive Suite 300 Kingsport |
| State: | TN US |
| Postal Code: | 376604653 |
| Phone Number: | 4238576300 |
| Fax Number: | |
| NPI Enumeration Date: | 10/02/2006 |
| NPI Last Update Date: | 10/27/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QA1903X |
| License Number: | 0000000113 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | TN |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Ambulatory Surgical |
| Taxonomy Definition: | |