Healthcare Provider Details

I. General information

NPI: 1144437716
Provider Name (Legal Business Name): WELLMONT HEALTH SYSTEM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2007
Last Update Date: 01/09/2023
Certification Date: 01/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 GREENWAY ST
KINGSPORT TN
37660-3020
US

IV. Provider business mailing address

2000 GREENWAY STREET
KINGSPORT TN
37660
US

V. Phone/Fax

Practice location:
  • Phone: 423-224-6900
  • Fax: 423-224-3759
Mailing address:
  • Phone: 423-224-6900
  • Fax: 423-224-3759

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License NumberI-01
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License NumberACL0000000155
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License NumberACL0000000155
License Number StateTN

VIII. Authorized Official

Name: AMY MARIE GREGORY
Title or Position: DIRECTOR
Credential: RN
Phone: 423-224-6900