Healthcare Provider Details

I. General information

NPI: 1871507426
Provider Name (Legal Business Name): WELLMONT HEALTH SYSTEM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 09/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

988 W MAIN ST
ABINGDON VA
24210
US

IV. Provider business mailing address

311 PRINCETON RD STE 1
JOHNSON CITY TN
37601-2026
US

V. Phone/Fax

Practice location:
  • Phone: 276-619-4500
  • Fax: 423-844-6379
Mailing address:
  • Phone: 276-619-4500
  • Fax: 423-844-6379

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code315D00000X
TaxonomyInpatient Hospice
License Number
License Number State

VIII. Authorized Official

Name: MARY LYNN KRUTAK
Title or Position: EVP/CFO
Credential:
Phone: 423-302-3423