1801826912 NPI number — WELLMONT HEALTH SYSTEM

Table of content: (NPI 1801826912)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801826912 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:
1801826912
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/16/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
311 PRINCETON RD STE 1
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JOHNSON CITY
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37601-2026
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
276-523-3111
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1990 HOLTON AVE E
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BIG STONE GAP
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
24219
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
276-523-3111
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HILTON
Authorized Official First Name:
SHANE
Authorized Official Middle Name:
EDWIN
Authorized Official Title or Position:
EVP/CFO
Authorized Official Telephone Number:
423-302-3467

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 000000064909 . This is a "KY BLUE CROSS" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 281670 . This is a "ANTHEM" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 004901142 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 033385600 . This is a "BLACK LUNG" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 166592402 . This is a "DEPT LABOR WORK COMP TN" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 3072953 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0166098400 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: A2421917 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 9810037000 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: A2421917 . This is a "UHC RIVER VALLEY" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 023718200 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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