Organization
KINGSPORT PRIMARY CARE, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SCOTT D MCLAIN MD (SUPERVISING PHYSICIAN)
(423) 246-0033
Entity
Organization
Contact information
Practice address
1526 BRIDGEWATER LN, KINGSPORT, TN 37660-4106
(423) 246-0033
(423) 245-0034
Mailing address
1526 BRIDGEWATER LN, KINGSPORT, TN 37660-4106
(423) 246-0033
(423) 245-0034
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
MD11895
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2403604
CIGNA
TN
01
—
3732429
MEDICARE PTAN
TN
05
—
3732429
—
TN
Enumeration date
11/30/2006
Last updated
10/07/2019
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