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Organization

KINGSPORT ENDOSCOPY CORPORATION

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
135 W RAVINE RD, SUITE 7A, KINGSPORT, TN 37660-3847
(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
0000000055
TN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000815
ANTHEM
VA
01
001000993
BCBS OF TN
TN
05
007641354
VA
01
100020225
PHP TENNCARE
TN
05
3287295
TN
05
36000412
KY
Enumeration date
09/12/2005
Last updated
05/04/2009
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