Organization
ENDOSCOPY CENTER OF KINGSPORT
Active
Organization
ENDOSCOPY CENTER OF KINGSPORT
Active
Other names
Sullivan Digestive Center
Organization subpart
No
Provider details
NPI number
Authorized official
MS. PENNY LEIGH LLOYD (ADMINISTRATOR)
(423) 392-6100
Entity
Organization
Contact information
Practice address
2204 PAVILION DR STE 108, KINGSPORT, TN 37660-4651
(423) 392-6100
(423) 392-6159
Mailing address
2204 PAVILION DR, SUITE 108, KINGSPORT, TN 37660-4657
(423) 392-6100
(423) 392-6159
Taxonomy
Speciality
Code
Description
License number
State
261QE0800X
Endoscopy Clinic/Center
Primary
0000000053
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1000910
BLUE CROSS BLUE SHIELD
TN
05
—
3287396
—
TN
Enumeration date
08/11/2006
Last updated
11/28/2023
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