| Indian Path Pavilion | |
|
2300 Pavilion Dr Kingsport TN 37660-4622 | |
| (423) 857-5500 | |
| (423) 857-7078 |
| Full Name | Indian Path Pavilion |
|---|---|
| Speciality | Psychiatric Unit |
| Location | 2300 Pavilion Dr, Kingsport, Tennessee |
| Authorized Official Name and Position | Mary L Krutak (SVP/CFO) |
| Authorized Official Contact | 4234316111 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Indian Path Pavilion 311 Princeton Rd Johnson City TN 37601-2026 Ph: (423) 431-1941 | Indian Path Pavilion 2300 Pavilion Dr Kingsport TN 37660-4622 Ph: (423) 857-5500 |
| NPI Number | 1417050980 |
|---|---|
| Provider Enumeration Date | 09/07/2006 |
| Last Update Date | 10/15/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1417050980 | NPI | - | NPPES |
| 4699873 | Medicaid | MI | |
| 000363855X | Medicaid | GA | |
| 004401760 | Medicaid | VA | |
| 01600113 | Medicaid | KY | |
| 091618800 | Medicaid | FL | |
| 0938025 | Medicaid | OH | |
| 17505000 | Other | MEGELLAN | |
| 000127730 | Medicaid | SC | |
| 00672239 | Medicaid | MS | |
| 4400176 | Medicaid | NC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 273R00000X | Psychiatric Unit | 0000000134 (Tennessee) | Primary |
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