MMDS of Kingsport, LLC

Primary specialty

Portable X-ray and/or Other Portable Diagnostic Imaging SupplierTaxonomy code 335V00000X

Legal business name

MMDS OF KINGSPORT, LLC

Practice address

1038 S Wilcox Dr
Suite 115
Kingsport, TN 37660-5378

Phone

(423) 230-8093

Fax

(423) 230-4932

NPI assigned

Oct 13, 2005

Organization subpart

No

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

Authorized official

Name

Mr. Lloyd M. Williams Jr.

Title

Owner

Phone

(423) 230-8093

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Portable X-ray supplier certification: CCN 44X0009827

Legal name

MMDS OF KINGSPORT, LLC

Certification status

Active

Provider type (POS)

Portable X-ray supplier

Participating since

Jun 20, 2005

Last certification

May 31, 2018

Ownership / control type

Corporation

Facility address

1038 South Wilcox Suite 115
Kingsport, TN 37660

Locations

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

{
    "created_epoch": "1129161600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1224028800000",
    "number": "1033107966",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1038 S WILCOX DR",
            "address_2": "SUITE 115",
            "city": "KINGSPORT",
            "state": "TN",
            "postal_code": "376605378",
            "telephone_number": "423-230-8093",
            "fax_number": "423-230-4932"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1038 S WILCOX DR",
            "address_2": "SUITE 115",
            "city": "KINGSPORT",
            "state": "TN",
            "postal_code": "376605378",
            "telephone_number": "423-230-8093",
            "fax_number": "423-230-4932"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MMDS OF KINGSPORT, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-13",
        "last_updated": "2008-10-15",
        "status": "A",
        "authorized_official_last_name": "WILLIAMS",
        "authorized_official_first_name": "LLOYD",
        "authorized_official_middle_name": "M.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "423-230-8093",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "335V00000X",
            "taxonomy_group": "",
            "desc": "Portable X-ray and/or Other Portable Diagnostic Imaging Supplier",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAIL ROAD",
            "identifier": "P00237335",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Dana Mitchell
• Kristina Elizabeth Mitchem, CRNA
• Amy E. Mize, LPE
• Howard Mize Jr., M.D.
• MMDS Idtf LLC
• MMDS, LLC (Stat Xrays)
• Eric David Moffet, MD
• Jennifer Leigh Mongold, MA
• Amy R Monroe, DPT
• Callie Darlene Montgomery, F.N.P.

• Portable X-ray and/or Other Portable Diagnostic Imaging Supplier in Kingsport, TN
• Providers in Kingsport, TN by specialty
• Portable X-ray and/or Other Portable Diagnostic Imaging Supplier in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.