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General NPI Number Information
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NPI Number | 1306898416
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Entity Type | Organization
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Legal Business Name | KINGSPORT BRONCHOSCOPY CENTER, INC.
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Dates
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Enumeration Date | 05/17/2006
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Last Update Date | 02/28/2008
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Provider Practice Location Address
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Address Line | 111 W STONE DR SUITE 100
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City | KINGSPORT
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State | TN
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Zip | 37660-6027
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Country | US
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Telephone | 423-247-5197
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Fax | 423-247-5254
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Provider Business Mailing Address
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Address Line | 111 W STONE DR SUITE 100
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City | KINGSPORT
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State | TN
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Zip | 37660-6027
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Country | US
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Telephone | 423-247-5197
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Fax | 423-247-5254
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | SHIRLEY HAWKINS
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Credential |
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Telephone | 423-247-5197
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | 0000000054
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License Number State | TN
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