Organization
KINGSPORT BRONCHOSCOPY CENTER, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHIRLEY HAWKINS (ADMINISTRATOR)
(423) 247-5197
Entity
Organization
Contact information
Practice address
111 W STONE DR, SUITE 100, KINGSPORT, TN 37660-6027
(423) 247-5197
(423) 247-5254
Mailing address
111 W STONE DR, SUITE 100, KINGSPORT, TN 37660-6027
(423) 247-5197
(423) 247-5254
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
0000000054
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1000908
BLUE CROSS BLUE SHIELD
TN
05
—
3287305
—
TN
Enumeration date
05/17/2006
Last updated
02/28/2008
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