# KINGSPORT PRIMARY HEALTHCARE, LLC

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

## Provider details

- **NPI number:** 1679074892
- **Authorized official:** STAN MCLAIN MD (MEDICAL DIRECTOR)
- **Authorized official phone:** (313) 363-6325

## Contact information

- **Practice address:** 1526 BRIDGEWATER LN, KINGSPORT, TN 37660-4106
- **Practice address phone:** (423) 246-0033
- **Practice address fax:** (423) 245-0034
- **Mailing address:** 4980 RANDEL RD, ONEIDA, NY 13421-3515
- **Mailing address phone:** (315) 363-6325
- **Mailing address fax:** (315) 363-6325

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | MD39507 | TN | Yes |

## Other

- **Enumeration date:** 02/22/2018
- **Last updated:** 02/22/2018