Organization
KINGSPORT PRIMARY HEALTHCARE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STAN MCLAIN MD (MEDICAL DIRECTOR)
(313) 363-6325
Entity
Organization
Contact information
Practice address
1526 BRIDGEWATER LN, KINGSPORT, TN 37660-4106
(423) 246-0033
(423) 245-0034
Mailing address
4980 RANDEL RD, ONEIDA, NY 13421-3515
(315) 363-6325
(315) 363-6325
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD39507
TN
Other
Enumeration date
02/22/2018
Last updated
02/22/2018
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