Healthcare Provider Details

I. General information

NPI: 1386657161
Provider Name (Legal Business Name): WELLMONT HEALTH SYSTEM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2006
Last Update Date: 04/16/2024
Certification Date: 04/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 15TH ST NW
NORTON VA
24273-1616
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 276-439-1350
  • Fax: 276-679-9011
Mailing address:
  • Phone: 276-439-1350
  • Fax: 276-679-9011

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code273Y00000X
TaxonomyRehabilitation Hospital Unit
License NumberH1879
License Number StateVA

VIII. Authorized Official

Name: SHANE EDWIN HILTON
Title or Position: EVP/CFO
Credential:
Phone: 423-302-3467