NPIMap

Organization Active NPI

Wellmont Physician Services Inc

  • Obstetrics & Gynecology Physician
  • Big Stone Gap, VA
National Provider Identifier
1043339385
Registry record updated Apr 22, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
Legal business name
WELLMONT PHYSICIAN SERVICES INC
Practice address
1980 Holton Ave E
Suite 301
Big Stone Gap, VA 24219-3366
Phone
(276) 523-0390
Fax
(423) 523-5514
NPI assigned
Mar 28, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 22, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Cindy M Locke, CPC CCS-P
Title
Billing Administrator
Phone
(423) 224-3250

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207V00000X Primary

Addresses

Primary practice location

1980 Holton Ave E
Suite 301
Big Stone Gap, VA 24219-3366

Mailing address

999 Executive Park Blvd
Suite 201
Kingsport, TN 37660-4632
Phone (423) 224-3250

Other identifiers 1

IdentifierTypeStateIssuer
65942757MedicaidKY

Other names 1

  • OB Gyn Clinic PC Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Wellmont Physician Services Inc16 organizations share this tax ID, including this one

Other organizations with this tax ID 15

Organizations that report the same tax identification number in the National Provider Directory.

View all 15

Locations

1980 Holton Ave E
Ste 301
Big Stone Gap, VA 24219
Phone (276) 523-0390

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1175040000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1271894400000",
    "number": "1043339385",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "999 EXECUTIVE PARK BLVD",
            "address_2": "SUITE 201",
            "city": "KINGSPORT",
            "state": "TN",
            "postal_code": "376604632",
            "telephone_number": "423-224-3250",
            "fax_number": "423-224-3258"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1980 HOLTON AVE E",
            "address_2": "SUITE 301",
            "city": "BIG STONE GAP",
            "state": "VA",
            "postal_code": "242193366",
            "telephone_number": "276-523-0390",
            "fax_number": "423-523-5514"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WELLMONT PHYSICIAN SERVICES INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-28",
        "last_updated": "2010-04-22",
        "status": "A",
        "authorized_official_last_name": "LOCKE",
        "authorized_official_first_name": "CINDY",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "BILLING ADMINISTRATOR",
        "authorized_official_telephone_number": "423-224-3250",
        "authorized_official_credential": "CPC CCS-P"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Obstetrics & Gynecology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "65942757",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "OB Gyn Clinic PC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Big Stone Gap, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 22, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.