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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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