MEDICARE: WELLMONT HEALTH SYSTEM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	273Y00000X	Rehabilitation Hospital Unit

General Provider Information

NPI Number	:	1376736637
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WELLMONT HEALTH SYSTEM

Provider Business Mailing Address
First Line	:	PO BOX 1089
Second Line	:
City	:	BRISTOL
State	:	TN
Zip	:	37621-1089
Country	:	US
Telephone Number	:	423-844-4711
Fax Number	:

Provider Business Practice Location Address
First Line	:	127 HEALTH CARE DR
Second Line	:
City	:	PENNINGTON GAP
State	:	VA
Zip	:	24277-2853
Country	:	US
Telephone Number	:	276-546-1440
Fax Number	:

Authorized Official
Title or Position	:	V.P.
Name	:	MS. ALICE POPE
Credential	:
Telephone Number	:	423-230-8200

Provider Enumeration Date	:	08/21/2007
Last Update Date	:	11/03/2011

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Directions to “WELLMONT HEALTH SYSTEM ” Practice Location

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