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General NPI Number Information
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NPI Number | 1366560161
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Entity Type | Organization
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Legal Business Name | WELLMONT PHYSICIAN SERVICES INC
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Dates
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Enumeration Date | 03/27/2007
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Last Update Date | 11/05/2010
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Provider Practice Location Address
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Address Line | 1 CLOVERLEAF SQ SUITE F1
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City | BIG STONE GAP
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State | VA
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Zip | 24219-2758
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Country | US
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Telephone | 276-523-6175
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Fax | 276-523-6719
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Provider Business Mailing Address
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Address Line | 999 EXECUTIVE PARK BLVD SUITE 201
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City | KINGSPORT
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State | TN
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Zip | 37660-4632
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Country | US
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Telephone | 423-224-3250
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Fax | 423-224-3258
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Authorized Official
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Title or Position | BILLING ADMINISTRATOR
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Name | CINDY M LOCKE
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Credential | CPC CCS-P
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Telephone | 423-224-3250
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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