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KINGSPORT DAY SURGERY
NPI 1053404574
Clinic/Center - Ambulatory Surgical in Kingsport, TN

Active since October 02, 2006
2204 PAVILION DRIVE, SUITE 300, KINGSPORT, TN 37660(423) 857-6300(423) 857-6324 Get Directions Write a Review

NPPES record last updated: January 14, 2020. Verified against the NPPES registry weekly; last sync: August 16, 2026.

Record update history: Jan 14, 2020, Feb 13, 2018, Nov 6, 2017 and 1 more (4 updates tracked since 2017).

About Kingsport Day Surgery NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

KINGSPORT DAY SURGERY (NPI 1053404574) is a healthcare organization registered as an ambulatory surgical in Kingsport, Tennessee and active in the NPI registry since October 2006. The organization lists Jenetha D Moran, Officer/authorized Official, as its authorized official.

NPPES Registry Identity

NPI1053404574
Entity TypeOrganization
Primary Taxonomy261QA1903X
Legal Business NameKINGSPORT AMBULATORY SURGERY CTR
Location Address2204 PAVILION DRIVE, SUITE 300Kingsport, TN 37660-4653
Mailing Address14201 Dallas PkwyDallas, TX 75254-2916 · (972) 763-3859 · Fax (972) 920-3445
Phone(423) 857-6300
Fax(423) 857-6324
Organization SubpartNo
Authorized OfficialJenetha D MoranOfficer/authorized Official · (972) 763-3893
Enumeration DateOctober 2, 2006
Last NPPES UpdateJanuary 14, 20204 updates tracked since enumeration
✔ NPI 1053404574 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyClinic/Center · Ambulatory SurgicalAmbulatory Health Care Facilities
Taxonomy Code261QA1903X
License✔ Licensed in TN · 0000000113
2204 PAVILION DRIVE, Kingsport, TN 37660
Open in Google Maps ↗

Other Names 1

Doing Business AsKingsport Day Surgery

Other Identifiers 10

Medicaid3288120TN
Medicaid007603177VA
Other100032523Php
Medicaid170411602TX
Other227545Anthem
Medicaid091618800FL
Other3148953Blue Cross
Medicaid36001311KY
Other7254600Cigna
OtherA3766000John Deere

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. ELICIA NICHOLE WHITE PHARMD
Pharmacist (Ambulatory Care)
2204 PAVILION DRIVE
KINGSPORT, TN 37660
Sullivan County (423) 224-1245

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Kingsport Ambulatory Surgery Ctr's NPI number?

The NPI number for Kingsport Ambulatory Surgery Ctr is 1053404574. It was assigned to this organization in the NPPES registry on October 2, 2006. The provider is doing business as Kingsport Day Surgery.

Where is Kingsport Ambulatory Surgery Ctr located?

Kingsport Ambulatory Surgery Ctr is located at 2204 Pavilion Drive Suite 300, Kingsport, TN 37660. The listed phone number is (423) 857-6300.

What is Kingsport Ambulatory Surgery Ctr's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Ambulatory Surgical, with taxonomy code 261QA1903X.

When was this NPI record last updated?

The NPPES record for Kingsport Ambulatory Surgery Ctr was last updated on January 14, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.