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General NPI Number Information
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NPI Number | 1861528747
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Entity Type | Organization
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Legal Business Name | MMDS OF KINGSPORT LLC
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Dates
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Enumeration Date | 02/26/2007
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Last Update Date | 06/16/2008
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Provider Practice Location Address
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Address Line | 367 NATURES WAY DR
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City | DUFFIELD
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State | VA
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Zip | 24244-5153
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Country | US
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Telephone | 423-230-8093
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Fax | 423-230-4932
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Provider Business Mailing Address
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Address Line | 1038 S WILCOX DR SUITE # AA
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City | KINGSPORT
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State | TN
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Zip | 37660-5378
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Country | US
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Telephone | 423-230-8093
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Fax | 423-230-4932
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Authorized Official
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Title or Position | OWNER
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Name | LLOYD WILLIAMS
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Credential |
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Telephone | 432-230-8093
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 335V00000X
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Taxonomy Name | Portable X-ray and/or Other Portable Diagnostic Imaging Supplier
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License Number |
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License Number State |
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