Organization Name:  KINGSPORT ENDOSCOPY CORPORATION


Practice Location:
135 W RAVINE RD SUITE 7A KINGSPORT, TN 37660 US
Tel: 423-246-6777  Fax: --

Business Mailing Address:
  ,   
Tel: --  Fax: --


Taxonomy:

Primary	Code	Category/Description	State	License Number
Y	261QA1903X	Ambulatory Health Care Facilities Clinic/Center Ambulatory Surgical	TN	0000000055

Other Provider Identifiers:

Issuer	Number	State	Type
PHP TENNCARE	100020225	TN	01
BCBS OF TN	001000993	TN	01
ANTHEM	000815	VA	01
	007641354	VA	05
	3287295	TN	05
	36000412	KY	05

Code values:
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin