KINGSPORT AMBULATORY SURGERY CTR (NPI# 1053404574) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1053404574 |
| Entity Type | Organization |
| Organization Name | KINGSPORT AMBULATORY SURGERY CTR |
| Other Organization Name | KINGSPORT DAY SURGERY |
| Practice Address |
2204 Pavilion Drive Suite 300 Kingsport TN 37660-4653 |
| Mailing Address |
14201 Dallas Pkwy Dallas TX 75254-2916 |
| Practice Telephone | 4238576300 |
| Practice Fax Number | 4238576324 |
| Mailing Telephone | 9727633859 |
| Mailing Fax Number | 9729203445 |
| Enumeration Date | 2006-10-02 |
| Last Update Date | 2020-01-14 |
| Authorized Official Name | JENETHA D MORAN (OFFICER/AUTHORIZED OFFICIAL) |
| Authorized Official Telephone | 9727633893 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QA1903X |
Clinic/Center Specialization: Ambulatory Surgical |
0000000113 | TN | Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| TN | 3288120 | 05 | |
| VA | 007603177 | 05 | |
| PHP | 100032523 | 01 | |
| TX | 170411602 | 05 | |
| ANTHEM | 227545 | 01 | |
| FL | 091618800 | 05 | |
| BLUE CROSS | 3148953 | 01 | |
| KY | 36001311 | 05 | |
| CIGNA | 7254600 | 01 | |
| JOHN DEERE | A3766000 | 01 |
| Other Name | Type Code |
|---|---|
| Kingsport Day Surgery | Doing Business As Name - Organization |
| Street Address |
2204 PAVILION DRIVE SUITE 300 |
| City | KINGSPORT |
| State | TN |
| Zip Code | 37660-4653 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1699158543 | Elicia Nichole White | Pharmacist | 2204 Pavilion Drive, Kingsport, TN 37660 | 2015-07-09 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1750909891 | Nancy Gober | Pharmacist | Holston Valley Medical Center Inpatient Pharmacy, 130 W Ravine, Kingsport, TN 37660 | 2020-07-06 |
| 1700437621 | Tammy Denise Leblanc | Technician | 125 Lancer Rd, Kingsport, TN 37660 | 2019-09-23 |
| 1831743392 | Independent Physical Therapy | Occupational Therapist | 1704 E. Stone Dr. Ste 120, Kingsport, TN 37660 | 2019-08-01 |
| 1871095315 | Macie Anderson | Nurse Practitioner | 411 Clay St, Kingsport, TN 37660 | 2018-03-01 |
| 1053813527 | Pulitzer Orthodontics, LLC | Dentist | 1200 Pulitzer Place, Kingsport, TN 37660 | 2018-03-01 |
| 1174038749 | Sbh-kingsport | Psychiatric Hospital | 1025 Executive Park Blvd, Kingsport, TN 37660 | 2017-12-05 |
| 1548771447 | Sara B Ball | Registered Nurse | 111 W Stone Dr Ste 240, Kingsport, TN 37660 | 2017-10-18 |
| 1821525361 | Ashley Brook Weems | Nurse Practitioner | Six Sheridan Square Suite 100, Kingsport, TN 37660 | 2017-05-15 |
| 1639625643 | Stephanie H Garris | Nurse Practitioner | 117 W Sevier Ave Ste 120, Kingsport, TN 37660 | 2016-08-30 |
| 1073965679 | Teresa Anne Starke | Physician Assistant | 8 Sheridan Square, Suite 110, Kingsport, TN 37660 | 2016-07-07 |
| Find all providers in zip 37660 | ||||
| Taxonomy Code | 261QA1903X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Ambulatory Surgical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629536826 | Meadowview Asc, LLC | Clinic/Center | 2033 Meadowview Ln Ste 210, Kingsport, TN 37660-7569 | 2019-03-06 |
| 1356396857 | Holston Valley Ambulatory Surgery Center, LLC | Clinic/Center | 103 W Stone Dr, Kingsport, TN 37660-3220 | 2006-05-23 |
| 1649244211 | Kingsport Tn Ophthalmology Asc LLC | Clinic/Center | 999 Executive Park Blvd, Suite 100, Kingsport, TN 37660-4632 | 2006-02-13 |
| 1306898416 | Kingsport Bronchoscopy Center, Inc. | Clinic/Center | 111 W Stone Dr, Suite 100, Kingsport, TN 37660-6027 | 2006-05-17 |
| 1578558078 | Kingsport Endoscopy Corporation | Clinic/Center | 135 W Ravine Rd, Suite 7a, Kingsport, TN 37660-3847 | 2005-09-12 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255939559 | Endoscopy Center of St Thomas Lp | Clinic/Center | 4230 Harding Pike Ste 309b, Nashville, TN 37205-2013 | 2020-10-09 |
| 1790344182 | Bristol Ambulatory Surgery Center, LLC | Clinic/Center | 350 Blountville Hwy Ste 108, Bristol, TN 37620-1676 | 2019-06-10 |
| 1528622321 | Premier-covenant Astc LLC | Clinic/Center | 6408 Papermill Dr Ste 220, Knoxville, TN 37919-4858 | 2019-04-26 |
| 1790348142 | The Plastic Surgery Center Brentwood | Clinic/Center | 620 Church Street East, Brentwood, TN 37027 | 2019-04-20 |
| 1326508045 | Eye Surgery Center of Lenoir City, LLC | Clinic/Center | 5491 Creekwood Park Blvd Ste B, Lenoir City, TN 37772-1204 | 2019-03-20 |
| 1780157990 | Renaissance Surgery Center, LLC | Clinic/Center | 320 Bristol West Blvd Ste 1a, Bristol, TN 37620-8773 | 2019-01-10 |
| 1619487782 | Uch Vascular Access Asc LLC | Clinic/Center | 6490 Mt Moriah Rd Ext Ste 202, Memphis, TN 38115-3841 | 2017-10-03 |
| 1841712452 | Saint Thomas Surgery Center New Salem, LLC | Clinic/Center | 2755 New Salem Highway, Murfreesboro, TN 37128-3712 | 2017-07-14 |
| 1255860383 | Eye Surgery Center of Knoxville, LLC | Clinic/Center | 7739 Dannaher Drive, Powell, TN 37849 | 2017-06-12 |
| 1871960153 | Turner Surgery Center, LLC | Clinic/Center | 28 White Bridge Rd Ste 210, Nashville, TN 37205-1467 | 2015-08-21 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.