Provider Demographics
NPI:1871547794
Name:PULMONARY ASSOCIATES OF KINGSPORT
Entity type:Organization
Organization Name:PULMONARY ASSOCIATES OF KINGSPORT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SHIRLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:HAWKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-247-5197
Mailing Address - Street 1:111 W STONE DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37660-6027
Mailing Address - Country:US
Mailing Address - Phone:423-247-5197
Mailing Address - Fax:423-247-5254
Practice Address - Street 1:2050 MEADOWVIEW PKWY
Practice Address - Street 2:SUITE 205
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660-7332
Practice Address - Country:US
Practice Address - Phone:423-247-9075
Practice Address - Fax:423-245-7953
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-22
Last Update Date:2010-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA055800OtherANTHEM
TN3700107Medicaid
TN85538OtherBLUE CROSS BLUE SHIELD
KY65906208OtherKENTUCKY MEDICAID
TN3700107Medicaid