Provider Demographics
NPI:1760567648
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:GENERAL MANAGER SECRETARY
Authorized Official - Prefix:MS
Authorized Official - First Name:VERONICA
Authorized Official - Middle Name:L
Authorized Official - Last Name:HAMMETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-477-9807
Mailing Address - Street 1:PO BOX 8839
Mailing Address - Street 2:
Mailing Address - City:GRAY
Mailing Address - State:TN
Mailing Address - Zip Code:37615
Mailing Address - Country:US
Mailing Address - Phone:423-477-9806
Mailing Address - Fax:423-477-3571
Practice Address - Street 1:1410 TUSCULUM BLVD
Practice Address - Street 2:SUITE 1600
Practice Address - City:GREENEVILLE
Practice Address - State:TN
Practice Address - Zip Code:37745-4286
Practice Address - Country:US
Practice Address - Phone:423-525-2442
Practice Address - Fax:423-477-3571
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-26
Last Update Date:2012-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1454285Medicaid
TN1454285Medicaid