Healthcare Provider Details

I. General information

NPI: 1376736637
Provider Name (Legal Business Name): WELLMONT HEALTH SYSTEM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2007
Last Update Date: 11/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

127 HEALTH CARE DR
PENNINGTON GAP VA
24277-2853
US

IV. Provider business mailing address

PO BOX 1089
BRISTOL TN
37621-1089
US

V. Phone/Fax

Practice location:
  • Phone: 276-546-1440
  • Fax:
Mailing address:
  • Phone: 423-844-4711
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code273Y00000X
TaxonomyRehabilitation Hospital Unit
License Number
License Number State

VIII. Authorized Official

Name: MS. ALICE POPE
Title or Position: V.P.
Credential:
Phone: 423-230-8200