1437304474 NPI number — WELLMONT HEALTH SYSTEM

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437304474 NPI number — WELLMONT HEALTH SYSTEM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WELLMONT HEALTH SYSTEM
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
JENKINS COMMUNITY HOSPITAL LABORATORY
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1437304474
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/18/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1 MEDICAL PARK BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BRISTOL
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37620-7430
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
423-844-4711
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9480 HIGHWAY 805
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JENKINS
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41537-8182
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-832-2171
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/18/2008

Additional Information

Authorized Official

Authorized Official Last Name:
KNIGHT
Authorized Official First Name:
CHRISTOPHER
Authorized Official Middle Name:
D
Authorized Official Title or Position:
EXEC VP/CFO
Authorized Official Telephone Number:
423-230-8200

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 65904294 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".




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