| Holston Medical Group Pc | |
|
105 W Stone Dr 3a Kingsport TN 37660-3256 | |
| (423) 392-6200 | |
| (423) 392-6583 |
| Full Name | Holston Medical Group Pc |
|---|---|
| Speciality | Family Medicine |
| Location | 105 W Stone Dr, Kingsport, Tennessee |
| Authorized Official Name and Position | Alicia Wright (MD, MEDICAL DIRECTOR) |
| Authorized Official Contact | 4238572066 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Holston Medical Group Pc Po Box 9 Kingsport TN 37662-0009 Ph: (423) 857-2066 | Holston Medical Group Pc 105 W Stone Dr 3a Kingsport TN 37660-3256 Ph: (423) 392-6200 |
| NPI Number | 1831110667 |
|---|---|
| Provider Enumeration Date | 07/21/2006 |
| Last Update Date | 06/29/2023 |
| Certification Date | 03/11/2021 |
| Medicare PECOS PAC ID | 8224935754 |
|---|---|
| Medicare Enrollment ID | O20031215000268 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1831110667 | NPI | - | NPPES |
| 3720182 | Medicaid | TN | |
| 3720183 | Medicaid | TN | |
| 3720184 | Medicaid | TN | |
| 3720181 | Medicaid | TN |
| Provider Name | Lawrence Delmore Bailey |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1437134723 PECOS PAC ID: 4880774264 Enrollment ID: I20101011000856 |
| Provider Name | Joyce L Henson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1861756611 PECOS PAC ID: 0345498226 Enrollment ID: I20120918000855 |
| Provider Name | Neil Hamilton |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1417938408 PECOS PAC ID: 3870498397 Enrollment ID: I20160720002962 |
| Provider Name | Michael Matthew Compton |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1902322126 PECOS PAC ID: 3870850811 Enrollment ID: I20171215000829 |
| Provider Name | Macy Garland Cox |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1972142529 PECOS PAC ID: 4981030772 Enrollment ID: I20200215000029 |
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