Provider Demographics
NPI:1083824379
Name:HAROLD D. KISTNER CONSTRUCTION COMPANY, INC.
Entity Type:Organization
Organization Name:HAROLD D. KISTNER CONSTRUCTION COMPANY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SEC., TREAS.
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:REED
Authorized Official - Last Name:KISTNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:276-669-7724
Mailing Address - Street 1:725 DAKOTA RD
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:VA
Mailing Address - Zip Code:24201-2911
Mailing Address - Country:US
Mailing Address - Phone:276-669-7724
Mailing Address - Fax:276-669-1116
Practice Address - Street 1:725 DAKOTA RD
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:VA
Practice Address - Zip Code:24201-2911
Practice Address - Country:US
Practice Address - Phone:276-669-7724
Practice Address - Fax:276-669-1116
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN00020118171WH0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171WH0202XOther Service ProvidersContractorHome ModificationsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0445837OtherBUREAU OF TENNCARE