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Kingsport Ambulatory Surgery Ctr

Ambulatory Surgical Clinic/Center in Kingsport, TN · enumerated 2006 · authorized official Jenetha Moran, Officer/Authorized Official.

Data current as of Jul 13, 2026 · sourced from CMS NPPES

National Provider Identifier

1053404574

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Registry record

Entity type Organization (Type 2)
Legal business name Kingsport Ambulatory Surgery Ctr
Other name <Unavail>
Practice address 2204 Pavilion Drive, Suite 300, Kingsport, TN, 37660
Fax (423) 857-6324
Enumeration date Oct 2, 2006
Last updated in NPPES Jan 14, 2020

Taxonomy & classification

261QA1903X Ambulatory Surgical Clinic/Center Ambulatory Health Care Facilities · License 0000000113 (TN) Primary

Authorized official

Name Jenetha Moran
Title Officer/Authorized Official

Other identifiers

Identifier Type State Issuer
100032523 Other - PHP
170411602 Medicaid TX -
36001311 Medicaid KY -
A3766000 Other - JOHN DEERE
227545 Other - ANTHEM
3148953 Other - BLUE CROSS
007603177 Medicaid VA -
091618800 Medicaid FL -
3288120 Medicaid TN -
7254600 Other - CIGNA

What is an NPI number?

A National Provider Identifier (NPI) is a unique 10-digit number that CMS assigns to every U.S. healthcare provider and organization under HIPAA. Type 1 NPIs identify individual providers; Type 2 NPIs identify organizations. The NPI appears on insurance claims, prescriptions, and credentialing paperwork, and never changes, even if the provider moves or changes specialty.

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Frequently asked questions

What is a Type 2 NPI?
A Type 2 NPI identifies an organization (group practice, hospital, pharmacy, lab), while Type 1 NPIs identify individual providers. Organizations bill under their Type 2 NPI.
What type of organization is Kingsport Ambulatory Surgery Ctr?
Kingsport Ambulatory Surgery Ctr is registered in NPPES as a Ambulatory Surgical Clinic/Center (its primary provider taxonomy).

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Source: CMS NPPES (public data). Snapshot 2026-07-13. Provider record last updated 2020-01-14.