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General NPI Number Information
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NPI Number | 1235443185
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Entity Type | Organization
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Legal Business Name | MEDISERVE MEDICAL EQUIPMENT OF KINGSPORT, INC.
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Dates
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Enumeration Date | 08/03/2010
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Last Update Date | 05/11/2012
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Provider Practice Location Address
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Address Line | 492 E MAIN ST
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City | ABINGDON
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State | VA
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Zip | 24210-3408
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Country | US
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Telephone | 276-628-2200
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Fax | 276-628-2206
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Provider Business Mailing Address
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Address Line | 492 E MAIN ST
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City | ABINGDON
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State | VA
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Zip | 24210-3408
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Country | US
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Telephone | 276-628-2200
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Fax | 276-628-2206
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. CARL STEVE KILGORE
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Credential |
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Telephone | 423-915-5184
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BX2000X
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Taxonomy Name | Oxygen Equipment & Supplies (DME)
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License Number | 468
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License Number State | TN
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