Organization
CENTENNIAL PHYSICIAN SERVICES, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KENNETH HEINRICH MD (PRESIDENT/OWNER)
(337) 609-1221
Entity
Organization
Contact information
Practice address
130 W RAVINE RD, KINGSPORT, TN 37660-3831
(423) 224-4000
Mailing address
200 CORPORATE BLVD, LAFAYETTE, LA 70508-3870
(800) 893-9698
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
363A00000X
Physician Assistant
—
—
363L00000X
Nurse Practitioner
—
—
Other
Enumeration date
04/13/2026
Last updated
04/13/2026
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