1902887680 NPI number — WELLMONT HEALTH SYSTEM, INC

Table of content: (NPI 1902887680)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902887680 NPI number — WELLMONT HEALTH SYSTEM, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WELLMONT HEALTH SYSTEM, INC
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:
WELLMONT BRISTOL REGIONAL MEDICAL CENTER HOME HEALTH
Provider Other Organization Name Type Code:
5
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:
1902887680
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
240 MEDICAL PARK BLVD
Provider Second Line Business Mailing Address:
SUITE 2600
Provider Business Mailing Address City Name:
BRISTOL
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37620-7346
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
423-844-5530
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
240 MEDICAL PARK BLVD
Provider Second Line Business Practice Location Address:
SUITE 2600
Provider Business Practice Location Address City Name:
BRISTOL
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37620-7346
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-844-5530
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/09/2005

Additional Information

Authorized Official

Authorized Official Last Name:
KAWCHAK
Authorized Official First Name:
CAROL
Authorized Official Middle Name:
J
Authorized Official Title or Position:
INTERIM DIRECTOR
Authorized Official Telephone Number:
423-230-8475

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  0000000248 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2024 www.npivalidator.com