Organization
EAST TENNESSEE ANESTHESIA PROVIDERS, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. VIKTOR P SULKOWSKI M.D. (OWNER)
(423) 854-0001
Entity
Organization
Contact information
Practice address
10461 WALLACE ALLEY ST, KINGSPORT, TN 37663-3936
(423) 279-1400
Mailing address
3101 BROWNS MILL RD STE 6 PMB 386, JOHNSON CITY, TN 37604-4100
(423) 854-0001
(423) 854-0002
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
MD0000010318
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3379190
—
TN
01
—
4051152
BCBS TN PROVIDER NUMBER
TN
01
—
4051167
BCBS TN GRP PROVIDER NUMB
TN
Enumeration date
08/31/2006
Last updated
10/21/2011
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