Healthcare Provider Details

I. General information

NPI: 1083824379
Provider Name (Legal Business Name): HAROLD D. KISTNER CONSTRUCTION COMPANY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 DAKOTA RD
BRISTOL VA
24201-2911
US

IV. Provider business mailing address

725 DAKOTA RD
BRISTOL VA
24201-2911
US

V. Phone/Fax

Practice location:
  • Phone: 276-669-7724
  • Fax: 276-669-1116
Mailing address:
  • Phone: 276-669-7724
  • Fax: 276-669-1116

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171WH0202X
TaxonomyHome Modifications Contractor
License Number00020118
License Number StateTN

VIII. Authorized Official

Name: MR. JOHN REED KISTNER
Title or Position: SEC., TREAS.
Credential:
Phone: 276-669-7724