Healthcare Provider Details

I. General information

NPI: 1588699144
Provider Name (Legal Business Name): HOLSTON VALLEY IMAGING CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 07/13/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 W STONE DR
KINGSPORT TN
37660-3220
US

IV. Provider business mailing address

3053 W STATE ST
BRISTOL TN
37620-1720
US

V. Phone/Fax

Practice location:
  • Phone: 423-224-4060
  • Fax:
Mailing address:
  • Phone: 423-224-4060
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License NumberODC 24
License Number StateTN

VIII. Authorized Official

Name: ALICE POPE
Title or Position: ATTORNEY
Credential:
Phone: 423-224-4000