Sam W. Huddleston IV MD PC

Primary specialty

SpecialistTaxonomy code 174400000X

License

MD15029 Issued in TN

Legal business name

SAM W. HUDDLESTON IV MD PC

Practice address

2002 Brookside Dr
Suite# 201
Kingsport, TN 37660-4634

Phone

(423) 245-7080

Fax

(423) 245-7875

NPI assigned

Oct 8, 2015

Organization subpart

No

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

Authorized official

Name

Dr. Sam W Huddleston, MD

Title

Owner

Phone

(423) 245-7080

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in TN

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Samuel W Huddleston IV, MD

  • Plastic and Reconstructive Surgery Physician
  • Kingsport, TN
  • NPI 1770508525
  Medicare reassignment NPD

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

{
    "created_epoch": "1444262400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1444262400000",
    "number": "1649641200",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2002 BROOKSIDE DR",
            "address_2": "SUITE# 201",
            "city": "KINGSPORT",
            "state": "TN",
            "postal_code": "376604634",
            "telephone_number": "423-245-7080",
            "fax_number": "423-245-7875"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2002 BROOKSIDE DR",
            "address_2": "SUITE# 201",
            "city": "KINGSPORT",
            "state": "TN",
            "postal_code": "376604634",
            "telephone_number": "423-245-7080",
            "fax_number": "423-245-7875"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAM W. HUDDLESTON IV MD PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-10-08",
        "last_updated": "2015-10-08",
        "status": "A",
        "authorized_official_last_name": "HUDDLESTON",
        "authorized_official_first_name": "SAM",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "423-245-7080",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Specialist",
            "state": "TN",
            "license": "MD15029",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Cody Phillip Salyer, PHARMD
• Gregory Todd Salyers, OD
• Halie Salyers
• Justin Salyers
• Timothy Edward Salyers, D.C.
• Sam'S Club Optical
• Ashley Samaniego, PMHNP-BC
• Stacey L Sampson
• Elijah Todd Samsel, FNP
• Jonmichael Samsel, DO

• Specialist in Kingsport, TN
• Providers in Kingsport, TN by specialty
• Specialist in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 8, 2015; 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.