Organization
SUGAR HOLLOW MEDICAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DAVID P GULDSETH MD (PRESIDENT)
(276) 466-3777
Entity
Organization
Contact information
Practice address
3177 LINDEN DR, SUITE #6, BRISTOL, VA 24202-5812
(276) 466-3777
(276) 466-3705
Mailing address
3177 LINDEN DR, SUITE #6, BRISTOL, VA 24202-5812
(276) 466-3777
(276) 466-3705
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
0101231449
VA
261QU0200X
Urgent Care Clinic/Center
0101231449
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00V083S29
MEDICARE
VA
01
—
246144
BLUE CROSS--VA
VA
01
—
4053485
BLUE CROSS -- TN
—
05
—
5629934
—
VA
Enumeration date
02/25/2008
Last updated
04/15/2008
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