1184812174 NPI number — WELLMONT HEALTH SYSTEM

Table of content: (NPI 1184812174)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184812174 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:
Provider Other Organization Name Type Code:
6
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:
1184812174
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/12/2008
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:
415 HIGHWAY 610 WEST SUITE 100
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VIRGIE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41572
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-639-0855
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/04/2007

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. V.P. / CFO
Authorized Official Telephone Number:
423-230-8200

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 31000896 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".




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