Organization
BRISTOL SURGICAL ASSOCIATES PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. JOHNNA BORDERS (ADMINISTRATOR)
(423) 844-6620
Entity
Organization
Contact information
Practice address
1 MEDICAL PARK BLVD, 250 WEST, BRISTOL, TN 37620-7430
(423) 844-6620
(423) 844-6627
Mailing address
1 MEDICAL PARK BLVD, 250 WEST, BRISTOL, TN 37620-7430
(423) 844-6620
(423) 844-6627
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
022276800
BLACK LUNG GROUP
TN
01
—
0636398
UMWA GROUP
TN
01
—
093410
ANTHEM BCBS VA GROUP
TN
05
—
3386543
—
TN
01
—
CA8128
RAILROAD MEDICARE GROUP
TN
01
—
F03906748
CHAMPUS GROUP
TN
Enumeration date
11/06/2006
Last updated
02/18/2014
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