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Holston Medical Group Pc

Family Medicine

Allopathic & Osteopathic Physicians

105 W Stone Dr, 3a, Kingsport, TN 37660-3256

(423) 392-6200 (423) 857-2066

PECOS Enrollment

Based on the most recent information from CMS, provider Holston Medical Group Pc does not have current enrollment records in PECOS.

Part B
Medicare Part B
Not Enrolled
HHA
Home Health Agency
Not Enrolled
DME
Durable Medical Equipment
Not Enrolled
PMD
Power Mobility Device
Not Enrolled

CMS last updated its PECOS records 2 days ago.

Profile Details

Provider ID
1831110667
Provider Type
Organization
Full Name
Holston Medical Group Pc

Subpart
No
Enumeration Date
7/21/2006
Last Updated
6/29/2023

Contact Information

Practice Location

105 W Stone Dr, 3a, Kingsport, TN 37660-3256

(423) 392-6200

(423) 392-6583

Mailing Location

PO Box 9, Kingsport, TN 37662-0009

(423) 857-2066

(423) 857-2070

Authorized Official

Wright, Alicia (Md, Medical Director)

(423) 857-2066

Provider Taxonomies

Code	Description	License
Code 207Q00000X Primary	Description Family Medicine Allopathic & Osteopathic Physicians	License Unlisted Issuer
Code 104100000X	Description Social Worker Behavioral Health & Social Service Providers	License Unlisted Issuer
Code 207R00000X	Description Internal Medicine Allopathic & Osteopathic Physicians	License Unlisted Issuer
Code 207V00000X	Description Obstetrics & Gynecology Allopathic & Osteopathic Physicians	License Unlisted Issuer
Code 207X00000X	Description Orthopaedic Surgery Allopathic & Osteopathic Physicians	License Unlisted Issuer
Code 207Y00000X	Description Otolaryngology Allopathic & Osteopathic Physicians	License Unlisted Issuer
Code 208000000X	Description Pediatrics Allopathic & Osteopathic Physicians	License Unlisted Issuer
Code 2080P0206X	Description Pediatrics Allopathic & Osteopathic Physicians	License Unlisted Issuer
Code 208100000X	Description Physical Medicine & Rehabilitation Allopathic & Osteopathic Physicians	License Unlisted Issuer
Code 2085B0100X	Description Radiology Allopathic & Osteopathic Physicians	License Unlisted Issuer
Code 208600000X	Description Surgery Allopathic & Osteopathic Physicians	License Unlisted Issuer
Code 208M00000X	Description Hospitalist Allopathic & Osteopathic Physicians	License Unlisted Issuer
Code 332B00000X	Description Durable Medical Equipment & Medical Supplies Suppliers	License Unlisted Issuer
Code 363A00000X	Description Physician Assistant Physician Assistants & Advanced Practice Nursing Providers	License Unlisted Issuer
Code 363L00000X	Description Nurse Practitioner Physician Assistants & Advanced Practice Nursing Providers	License Unlisted Issuer

Provider Identifiers

ID	Description	Issuer
ID 3720182	Description Medicaid	Issuer Unlisted Tennessee
ID 3720183	Description Medicaid	Issuer Unlisted Tennessee
ID 3720184	Description Medicaid	Issuer Unlisted Tennessee
ID 3720181	Description Medicaid	Issuer Unlisted Tennessee

Holston Medical Group Pc

PECOS Enrollment

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