Organization
SURGICAL ASSOCIATES OF KINGSPORT, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LISA O MULLINS (PRACTICE ADMINISTRATOR)
(423) 245-6101
Entity
Organization
Contact information
Practice address
444 CLINCHFIELD STREET, SUITE 2900, KINGSPORT, TN 37660-3858
(723) 245-6101
(423) 245-2396
Mailing address
444 CLINCHFIELD STREET, SUITE 2900, KINGSPORT, TN 37660-3858
(723) 245-6101
(423) 245-2396
Taxonomy
Speciality
Code
Description
License number
State
2085R0204X
Vascular & Interventional Radiology Physician
—
—
208600000X
Surgery Physician
Primary
—
—
2086S0127X
Trauma Surgery Physician
—
—
2086S0129X
Vascular Surgery Physician
—
—
2086X0206X
Surgical Oncology Physician
—
—
208C00000X
Colon & Rectal Surgery Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
20009693
RAILROAD MEDICARE GROUP #
—
01
—
2007130
BCBS TENNESSEE GROUP #
TN
Enumeration date
07/05/2006
Last updated
07/31/2015
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