Healthcare Provider Details

I. General information

NPI: 1033191044
Provider Name (Legal Business Name): WELLMONT HEALTH SYSTEM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CLOVERLEAF SQUARE BUILDING G
BIG STONE GAP VA
24219
US

IV. Provider business mailing address

2971 FORT HENRY DR
KINGSPORT TN
37664-4005
US

V. Phone/Fax

Practice location:
  • Phone: 276-523-8668
  • Fax: 276-523-8701
Mailing address:
  • Phone: 423-230-8443
  • Fax: 423-245-7874

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberNA
License Number StateVA

VIII. Authorized Official

Name: MS. BEVERLY A HOLLANDER
Title or Position: DIRECTOR
Credential: RN,MA
Phone: 423-230-8475