Provider Demographics
NPI:1790307569
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:EVP/CFO
Authorized Official - Prefix:
Authorized Official - First Name:SHANE
Authorized Official - Middle Name:EDWIN
Authorized Official - Last Name:HILTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-302-3467
Mailing Address - Street 1:311 PRINCETON RD STE 1
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37601-2080
Mailing Address - Country:US
Mailing Address - Phone:276-628-2200
Mailing Address - Fax:276-628-2206
Practice Address - Street 1:24530 FALCON PLACE BLVD STE 1E
Practice Address - Street 2:
Practice Address - City:ABINGDON
Practice Address - State:VA
Practice Address - Zip Code:24211-7665
Practice Address - Country:US
Practice Address - Phone:276-628-2200
Practice Address - Fax:276-628-2206
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-14
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies