MEDICARE: MEDISERVE MEDICAL EQUIPMENT OF KINGSPORT, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332BX2000X	Oxygen Equipment & Supplies (DME)	468	TN

General Provider Information

NPI Number	:	1235443185
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDISERVE MEDICAL EQUIPMENT OF KINGSPORT, INC.

Provider Business Mailing Address
First Line	:	492 E MAIN ST
Second Line	:
City	:	ABINGDON
State	:	VA
Zip	:	24210-3408
Country	:	US
Telephone Number	:	276-628-2200
Fax Number	:	276-628-2206

Provider Business Practice Location Address
First Line	:	492 E MAIN ST
Second Line	:
City	:	ABINGDON
State	:	VA
Zip	:	24210-3408
Country	:	US
Telephone Number	:	276-628-2200
Fax Number	:	276-628-2206

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. CARL STEVE KILGORE
Credential	:
Telephone Number	:	423-915-5184

Provider Enumeration Date	:	08/03/2010
Last Update Date	:	05/11/2012

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