Organization
THE ENDOSCOPY CENTER OF BRISTOL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MARK BARTLEY CPA (CHIEF ADMINISTRATIVE OFFICER)
(423) 246-6777
Entity
Organization
Contact information
Practice address
235 MEDICAL PARK BLVD, BRISTOL, TN 37620-7455
(423) 246-6777
(423) 246-7766
Mailing address
135 W RAVINE RD, SUITE 3A, KINGSPORT, TN 37660-3847
(423) 246-6777
(423) 246-7766
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
0000000114
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
004001475
BCBS OF TN
TN
05
—
007603819
—
VA
01
—
100036168
PHP TENNCARE
TN
05
—
3288515
—
TN
05
—
7603819
—
KY
Enumeration date
09/12/2005
Last updated
05/04/2009
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