| Dba Indian Path Pavilion | |
|
2300 Pavilion Dr Kingsport TN 37660-4622 | |
| (423) 392-5500 | |
| (423) 392-5597 |
| Full Name | Dba Indian Path Pavilion |
|---|---|
| Speciality | Psychiatry & Neurology - Psychiatry |
| Location | 2300 Pavilion Dr, Kingsport, Tennessee |
| Authorized Official Name and Position | C. Steven Kilgore (SENIOR VICE PRESIDENT) |
| Authorized Official Contact | 4239155185 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Dba Indian Path Pavilion 2300 Pavilion Dr Kingsport TN 37660-4622 Ph: (423) 392-5500 | Dba Indian Path Pavilion 2300 Pavilion Dr Kingsport TN 37660-4622 Ph: (423) 392-5500 |
| NPI Number | 1659475374 |
|---|---|
| Provider Enumeration Date | 09/12/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1659475374 | NPI | - | NPPES |
| 3716292 | Medicaid | TN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084A0401X | Psychiatry & Neurology - Addiction Medicine | (* (Not Available)) | Primary |
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Primary |
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