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Individual

WILLIAM D MCCOLL

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
CRNA

Contact information

Practice address
135 W RAVINE RD, SUITE 5B, KINGSPORT, TN 37660-3847
(423) 224-3460
(423) 224-3465
Mailing address
PO BOX 1308, KINGSPORT, TN 37662-1308
(423) 224-3460
(423) 224-3465

Taxonomy

Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
9531
TN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
00013859
NHC CARE ADMINISTRATORS
05
2603073000
WV
01
261962
ANTHEM BCBS
01
3046122
BLUE SHIELD OF TN
05
3607752
TN
01
74299447
KY MEDICAID
KY
05
8922837
VA
01
TN0100
JOHN DEERE
Enumeration date
09/16/2005
Last updated
08/17/2010
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