Healthcare Provider Details

I. General information

NPI: 1972782175
Provider Name (Legal Business Name): WELLMONT HEALTH SYSTEM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2007
Last Update Date: 11/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9480 HIGHWAY 805
JENKINS KY
41537-8182
US

IV. Provider business mailing address

1 MEDICAL PARK BLVD
BRISTOL TN
37620-7430
US

V. Phone/Fax

Practice location:
  • Phone: 606-832-2171
  • Fax:
Mailing address:
  • Phone: 423-844-4711
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number StateKY

VIII. Authorized Official

Name: MR. CHRISTOPHER D. KNIGHT
Title or Position: CFO/EXEC. V.P.
Credential:
Phone: 423-230-8200