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SAM W. HUDDLESTON IV MD PC
NPI 1649641200
Specialist in Kingsport, TN

Active since October 08, 2015
2002 BROOKSIDE DR, SUITE# 201, KINGSPORT, TN 37660(423) 245-7080(423) 245-7875 Get Directions Write a Review

NPPES record last updated: October 8, 2015. Verified against the NPPES registry weekly; last sync: October 18, 2026.

About Sam W. Huddleston Iv Md Pc NPPES

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

SAM W. HUDDLESTON IV MD PC (NPI 1649641200) is a healthcare organization registered as a specialist in Kingsport, Tennessee and active in the NPI registry since October 2015. The organization lists Sam W Huddleston, Owner, as its authorized official.

NPPES Registry Identity

NPI1649641200
Entity TypeOrganization
Primary Taxonomy174400000X
Legal Business NameSAM W. HUDDLESTON IV MD PC
Location Address2002 BROOKSIDE DR, SUITE# 201Kingsport, TN 37660-4634
Mailing Address2002 Brookside Dr, Suite# 201Kingsport, TN 37660-4634 · (423) 245-7080 · Fax (423) 245-7875
Phone(423) 245-7080
Fax(423) 245-7875
Organization SubpartNo
Authorized OfficialSam W HuddlestonOwner · (423) 245-7080
Enumeration DateOctober 8, 2015
✔ NPI 1649641200 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtySpecialistOther Service Providers
Taxonomy Code174400000X
License✔ Licensed in TN · MD15029
Definition
An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree.
2002 BROOKSIDE DR, Kingsport, TN 37660
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Other Identifiers 1

Medicare PIN3032417TN

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X MULTIPLE SINGLE SPECIALTY GROUP

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Sam W. Huddleston Iv Md Pc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

Medicare enrollment records show 1 clinician reassigns Medicare billing to Sam W. Huddleston IV MD PC, which bills Medicare for the services this clinician delivers.

Clinician (1)

Sam Huddleston, MD
Plastic and Reconstructive Surgery
NPI 1770508525
2002 BROOKSIDE DRIVE STE 201
Kingsport, TN 37660
(423) 245-7080
✔ PECOSSame address

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

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 Sam W. Huddleston IV MD PC's NPI number?

The NPI number for Sam W. Huddleston IV MD PC is 1649641200. It was assigned to this organization in the NPPES registry on October 8, 2015.

Where is Sam W. Huddleston IV MD PC located?

Sam W. Huddleston IV MD PC is located at 2002 Brookside Dr Suite# 201, Kingsport, TN 37660. The listed phone number is (423) 245-7080.

What is Sam W. Huddleston IV MD PC's specialty?

The primary specialty registered for this NPI is Specialist with taxonomy code 174400000X.

Is Sam W. Huddleston IV MD PC enrolled in Medicare?

Yes. Sam W. Huddleston IV MD PC is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Sam W. Huddleston IV MD PC?

According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Plastic and Reconstructive Surgery) reassigns their Medicare billing to Sam W. Huddleston IV MD PC. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

When was this NPI record last updated?

The NPPES record for Sam W. Huddleston IV MD PC was last updated on October 8, 2015. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 11 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.