# KINGSPORT ENDOSCOPY CORPORATION

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1578558078
- **Authorized official:** MR. MARK BARTLEY CPA (CHIEF ADMINISTRATIVE OFFICER)
- **Authorized official phone:** (423) 246-6777

## Contact information

- **Practice address:** 135 W RAVINE RD, SUITE 7A, KINGSPORT, TN 37660-3847
- **Practice address phone:** (423) 246-6777
- **Practice address fax:** (423) 246-7766
- **Mailing address:** 135 W RAVINE RD, SUITE 3A, KINGSPORT, TN 37660-3847
- **Mailing address phone:** (423) 246-6777
- **Mailing address fax:** (423) 246-7766

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QA1903X | Ambulatory Surgical Clinic/Center | 0000000055 | TN | Yes |

## Other

- **Enumeration date:** 09/12/2005
- **Last updated:** 05/04/2009

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 000815 | ANTHEM | VA |
| 01 | — | 001000993 | BCBS OF TN | TN |
| 05 | — | 007641354 | — | VA |
| 01 | — | 100020225 | PHP TENNCARE | TN |
| 05 | — | 3287295 | — | TN |
| 05 | — | 36000412 | — | KY |