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General NPI Number Information
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NPI Number | 1902887680
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Entity Type | Organization
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Legal Business Name | WELLMONT HEALTH SYSTEM, INC
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Dates
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Enumeration Date | 11/09/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 240 MEDICAL PARK BLVD SUITE 2600
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City | BRISTOL
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State | TN
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Zip | 37620-7346
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Country | US
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Telephone | 423-844-5530
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Fax |
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Provider Business Mailing Address
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Address Line | 240 MEDICAL PARK BLVD SUITE 2600
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City | BRISTOL
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State | TN
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Zip | 37620-7346
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Country | US
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Telephone | 423-844-5530
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Fax |
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Authorized Official
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Title or Position | INTERIM DIRECTOR
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Name | MRS. CAROL J KAWCHAK
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Credential |
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Telephone | 423-230-8475
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 0000000248
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License Number State | TN
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