NPIMap

Organization Active NPI

WPS Providers Inc

  • General Practice Physician
  • Kingsport, TN
National Provider Identifier
1003904095
Registry record updated May 10, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
Legal business name
WPS PROVIDERS INC
Practice address
130 W Ravine Rd
Kingsport, TN 37660-3837
Phone
(423) 224-4000
NPI assigned
Oct 11, 2006
Last updated
May 10, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 10, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Juanita L Harwood
Title
Director
Phone
(423) 302-6565

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Physician 208D00000X NU Primary

Addresses

Primary practice location

130 W Ravine Rd
Kingsport, TN 37660-3837

Mailing address

105 W Stone Dr
Suite 6a
Kingsport, TN 37660-3365
Phone (423) 408-7220

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN, VA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20070824000581 TN Part B Supplier - Clinic/Group Practice 7719079532 Receives reassigned benefits from 82 practitioners
Practice locations: Bristol, TN; Kingsport, TN; Johnson City, TN; Greeneville, TN
O20170227002082 VA Part B Supplier - Clinic/Group Practice 7719079532 Receives reassigned benefits from 39 practitioners
Practice locations: Marion, VA; Norton, VA; Bristol, VA; Abingdon, VA

National Provider Directory

National Provider Directory

Member of 2

Organizations this organization is a member of, according to the National Provider Directory.

Locations

1 Medical Park Blvd
Ste 3W
Bristol, TN 37620
Phone (423) 844-1121

350 Blountville Hwy
Ste 106
Bristol, TN 37620
Phone (423) 844-6120

3 Professional Park Dr
Ste 31
Johnson City, TN 37604
Phone (423) 232-6900

400 N State of Franklin Rd
Fl 7
Johnson City, TN 37604

103 W Stone Dr
Kingsport, TN 37660
Phone (423) 224-4050

105 W Stone Dr
Ste 4D
Kingsport, TN 37660
Phone (423) 392-6299

130 W Ravine Rd
#1
Kingsport, TN 37660

2 Sheridan Sq
Kingsport, TN 37660
Phone (423) 246-8061

2202 N John B Dennis Hwy
Ste 1
Kingsport, TN 37660

2202 N John B Dennis Hwy
Ste 110
Kingsport, TN 37660
Phone 4235788400 ext. 88500

2202 N John B Dennis Hwy
Ste 204
Kingsport, TN 37660
Phone (423) 224-3300

1341 E Main St
Rogersville, TN 37857
Phone (423) 293-3700

1519 Main St
Ste 33
Sneedville, TN 37869

Practitioners & affiliated clinicians

Practitioners 101

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 101

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1160524800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1715299200000",
    "number": "1003904095",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "105 W STONE DR",
            "address_2": "SUITE 6A",
            "city": "KINGSPORT",
            "state": "TN",
            "postal_code": "376603365",
            "telephone_number": "423-408-7220",
            "fax_number": "423-408-7405"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "130 W RAVINE RD",
            "city": "KINGSPORT",
            "state": "TN",
            "postal_code": "376603837",
            "telephone_number": "423-224-4000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WPS PROVIDERS INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-11",
        "last_updated": "2024-05-10",
        "certification_date": "2024-05-10",
        "status": "A",
        "authorized_official_last_name": "HARWOOD",
        "authorized_official_first_name": "JUANITA",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "423-302-6565"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kingsport, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 10, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.