Organization · Type 2 NPI

Kingsport Ambulatory Surgery CTR

Ambulatory Surgical Clinic/Center · Kingsport, TN

NPI number 1053404574 Active

Practice location

2204 Pavilion Drive, Suite 300
Kingsport, TN 37660-4653

Call (423) 857-6300 Map

Fax (423) 857-6324

Mailing address

14201 Dallas Pkwy
Dallas, TX 75254-2916

Specialties and licenses

Taxonomy	Code	License
Ambulatory Surgical Clinic/Center Primary	261QA1903X	0000000113 (TN)

Ambulatory Surgical Clinic/Center: Definition to come...

Another provider at this address

Elicia Nichole White, PharmDAmbulatory Care Pharmacist Kingsport, TN NPI 1699158543

Other ambulatory surgical clinic/center providers in Kingsport

See all in Kingsport →

NPI record

NPI: 1053404574
Entity type: Organization (Type 2)
Issued: Oct 2, 2006
Last updated: Jan 14, 2020
Status: Active

Other names

<unavail>
Kingsport Day Surgery · doing business as
Kingsport Day Surgery · doing business as

Authorized official

Jenetha D Moran
Officer/authorized Official
(972) 763-3893

Verify this record

This page mirrors the public NPPES file. For credentialing or billing, confirm it on the official CMS NPI Registry, and check the license with the state board.

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About NPI 1053404574

Kingsport Ambulatory Surgery CTR's National Provider Identifier is 1053404574, issued on Oct 2, 2006. The primary taxonomy on file is Ambulatory Surgical Clinic/Center (261QA1903X), and the practice location is in Kingsport, TN. The record was last updated on Jan 14, 2020.