Healthcare Provider Details

I. General information

NPI: 1548451909
Provider Name (Legal Business Name): WELLMONT HEALTH SYSTEM CARDIOLOGY FEES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2007
Last Update Date: 11/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 W RAVINE RD
KINGSPORT TN
37660-3837
US

IV. Provider business mailing address

1 MEDICAL PARK BLVD
BRISTOL TN
37620-7430
US

V. Phone/Fax

Practice location:
  • Phone: 423-224-4000
  • Fax:
Mailing address:
  • Phone: 423-844-4711
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246W00000X
TaxonomyCardiology Technician
License Number
License Number State

VIII. Authorized Official

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