Provider Demographics
NPI:1235443185
Name:MEDISERVE MEDICAL EQUIPMENT OF KINGSPORT, INC.
Entity Type:Organization
Organization Name:MEDISERVE MEDICAL EQUIPMENT OF KINGSPORT, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CARL
Authorized Official - Middle Name:STEVE
Authorized Official - Last Name:KILGORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-915-5184
Mailing Address - Street 1:492 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ABINGDON
Mailing Address - State:VA
Mailing Address - Zip Code:24210-3408
Mailing Address - Country:US
Mailing Address - Phone:276-628-2200
Mailing Address - Fax:276-628-2206
Practice Address - Street 1:492 E MAIN ST
Practice Address - Street 2:
Practice Address - City:ABINGDON
Practice Address - State:VA
Practice Address - Zip Code:24210-3408
Practice Address - Country:US
Practice Address - Phone:276-628-2200
Practice Address - Fax:276-628-2206
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BLUE RIDGE MANAGEMENT CORP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-08-03
Last Update Date:2012-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN468332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1235443185Medicare NSC