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General NPI Number Information
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NPI Number | 1972785855
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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 | 12/03/2007
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Last Update Date | 03/17/2008
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Provider Practice Location Address
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Address Line | 415 HWY 610 W SUITE 100
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City | VIRGIE
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State | KY
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Zip | 41572
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Country | US
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Telephone | 606-639-0855
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Fax | 606-639-2826
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Provider Business Mailing Address
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Address Line | PO BOX 37024
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City | BALTIMORE
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State | MD
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Zip | 21297-3024
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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 | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State | KY
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