{
"Npi": {
"NPI": "1770753444",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "WELLMONT PHYSICIAN SERVICES INC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": "6",
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "999 EXECUTIVE PARK BLVD",
"SecondLineMailingAddress": "SUITE 201",
"MailingAddressCityName": "KINGSPORT",
"MailingAddressStateName": "TN",
"MailingAddressPostalCode": "37660-4632",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "423-224-3250",
"MailingAddressFaxNumber": "423-224-3258",
"FirstLinePracticeLocationAddress": "111 W STONE DR",
"SecondLinePracticeLocationAddress": "SUITE 300",
"PracticeLocationAddressCityName": "KINGSPORT",
"PracticeLocationAddressStateName": "TN",
"PracticeLocationAddressPostalCode": "37660-6027",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "423-224-3150",
"PracticeLocationAddressFaxNumber": "423-224-3169",
"EnumerationDate": "03/10/2008",
"LastUpdateDate": "03/04/2010",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "LOCKE",
"AuthorizedOfficialFirstName": "CINDY",
"AuthorizedOfficialMiddleName": "M",
"AuthorizedOfficialTitle": "BILLING ADMINISTRATOR",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "CPC, CCS-P, CPC-I",
"AuthorizedOfficialTelephoneNumber": "423-224-3250",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "332900000X",
"TaxonomyName": "Non-Pharmacy Dispensing Site",
"LicenseNumber": null,
"LicenseNumberStateCode": "TN",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}