OrganizationKingsport Primary Healthcare, LlcFamily MedicineAllopathic & Osteopathic PhysiciansPractice Address1526 Bridgewater Ln, Kingsport, TN 37660-4106(423) 246-0033(315) 363-6325PECOS EnrollmentBased on the most recent information from CMS, provider Kingsport Primary Healthcare, Llc does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records yesterday at 4:18 PM.Profile DetailsProvider ID1679074892Provider TypeOrganizationFull NameKingsport Primary Healthcare, LlcSubpartNoEnumeration Date2/22/2018Last Updated2/22/2018Contact InformationPractice LocationPractice Address1526 Bridgewater Ln, Kingsport, TN 37660-4106Phone(423) 246-0033Fax(423) 245-0034Mailing LocationMailing Address4980 Randel Rd, Oneida, NY 13421-3515Phone(315) 363-6325Fax(315) 363-6325Authorized OfficialNameMclain, Stan (Medical Director)Phone(313) 363-6325Provider TaxonomiesCodeDescriptionLicenseCode207Q00000XPrimaryDescriptionFamily MedicineAllopathic & Osteopathic PhysiciansLicenseMD39507Tennessee