Holston Medical Group PC

Primary specialty

Medical Laboratory TechnicianTaxonomy code 246RM2200X

Legal business name

HOLSTON MEDICAL GROUP PC

Practice address

105 W Stone Dr
1H
Kingsport, TN 37660-3256

Phone

(423) 392-6200

Fax

(423) 392-6593

NPI assigned

Dec 19, 2006

Organization subpart

No

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

Authorized official

Name

Audra Lawson

Title

Contract Manager

Phone

(423) 857-2066

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Path Reference Lab Other name

Medicare fee-for-service enrollment

Enrolled in TN

Enrollment records 1

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

• Holston Medical Group PC

  • Family Medicine Physician
  • Kingsport, TN
  • NPI 1831110667

  O20031216000416

  Same enrollment

Locations

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

{
    "created_epoch": "1166486400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1291766400000",
    "number": "1356405120",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 9",
            "city": "KINGSPORT",
            "state": "TN",
            "postal_code": "376620009",
            "telephone_number": "423-857-2066",
            "fax_number": "423-857-2030"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "105 W STONE DR",
            "address_2": "1H",
            "city": "KINGSPORT",
            "state": "TN",
            "postal_code": "376603256",
            "telephone_number": "423-392-6200",
            "fax_number": "423-392-6593"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HOLSTON MEDICAL GROUP PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-19",
        "last_updated": "2010-12-08",
        "status": "A",
        "authorized_official_last_name": "LAWSON",
        "authorized_official_first_name": "AUDRA",
        "authorized_official_title_or_position": "CONTRACT MANAGER",
        "authorized_official_telephone_number": "423-857-2066"
    },
    "taxonomies": [
        {
            "code": "246RM2200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Technician, Pathology, Medical Laboratory",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000100137",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Path Reference Lab",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Katie Ward Holley, DO
• Brandon Chase Holliman, OD
• David Corbett Holliman, O.D.
• Melissa Marlo Holliman, O.D.
• Holston Manor SNF Operations LLC
• Holston Medical Group PC
• Holston Medical Group, PC
• Holston Medical Group, PC (Med Plaza Orthopaedics)
• Holston NH Operations LLC (Holston Manor)
• Holston Pediatric and Adolescent Care

• Medical Laboratory Technician in Kingsport, TN
• Providers in Kingsport, TN by specialty
• Medical Laboratory Technician in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 8, 2010; 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.