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General NPI Number Information
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NPI Number | 1609988930
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Entity Type | Organization
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Legal Business Name | KINGSPORT ANESTHESIA, PLC
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 302 WESLEY ST STE 3
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City | JOHNSON CITY
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State | TN
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Zip | 37601-1741
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Country | US
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Telephone | 423-283-7302
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Fax |
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Provider Business Mailing Address
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Address Line | 3101 BROWNS MILL RD STE 6 PMB 386
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City | JOHNSON CITY
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State | TN
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Zip | 37604-4100
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Country | US
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Telephone | 423-854-0001
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Fax | 423-854-0002
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Authorized Official
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Title or Position | OWNER
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Name | DR. LORNA K EHRENFRIED
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Credential | M.D.
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Telephone | 423-854-0001
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | MD0000034445
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License Number State | TN
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