Provider Demographics
NPI:1679058929
Name:BRISTOL COMPUTER SERVICES, INC.
Entity type:Organization
Organization Name:BRISTOL COMPUTER SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMIN. ASST./CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:BOOHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-968-4540
Mailing Address - Street 1:350 BLOUNTVILLE HWY STE 207
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:TN
Mailing Address - Zip Code:37620-1671
Mailing Address - Country:US
Mailing Address - Phone:423-968-4540
Mailing Address - Fax:423-968-5697
Practice Address - Street 1:3185 W STATE ST STE 2020
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:TN
Practice Address - Zip Code:37620-1600
Practice Address - Country:US
Practice Address - Phone:423-968-4141
Practice Address - Fax:423-968-4175
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-02
Last Update Date:2018-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty