NPIMap

Organization Active NPI

Wellmont Medical Associates, Inc.

Doing business as Ballad Health Imaging Center, Greeneville

  • Physiological Laboratory
  • Greeneville, TN
National Provider Identifier
1184299018
Registry record updated May 24, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physiological LaboratoryTaxonomy code 293D00000X
Legal business name
WELLMONT MEDICAL ASSOCIATES, INC.
Doing business as
Ballad Health Imaging Center, Greeneville
Practice address
438 E Vann Rd Ste 101
Greeneville, TN 37743-7202
Phone
(423) 278-1856
Fax
(423) 390-6945
NPI assigned
May 24, 2021
Last updated
May 24, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 24, 2021

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

Authorized official

Name
Mary L Krutak
Title
Evp/Cfo
Phone
(423) 302-3423

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physiological Laboratory 293D00000X Primary

Addresses

Primary practice location

438 E Vann Rd Ste 101
Greeneville, TN 37743-7202

Mailing address

311 Princeton Rd Ste 1
Johnson City, TN 37601-2080
Phone (423) 278-1856

Other names 1

  • Ballad Health Imaging Center, Greeneville Doing business as

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
44D2178879Ballad Health Medical Associates438 E Vann Road Suite 200, Greeneville, TN 37743Certificate of waiverFeb 10, 2028
44D2178892Ballad Health Medical Associates Internal Medicine438 E Vann Road Suite 201, Greeneville, TN 37743Certificate of waiverFeb 10, 2028
44D2178894Ballad Health Medical Associates Urgent Care438 East Vann Road, Suite 301, Greeneville, TN 37743Certificate of waiverFeb 10, 2028
44D2178903Ballad Health Medical Associates Family Medicine438 E Vann Road Suite 100, Greeneville, TN 37743Provider-performed microscopyFeb 10, 2028

National Provider Directory

National Provider Directory
Tax ID family
Wellmont Medical Assoc Inc13 organizations share this tax ID, including this one

Other organizations with this tax ID 12

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

Locations

438 E Vann Rd
Ste 101
Greeneville, TN 37743
Phone (423) 278-1856

NPI Registry JSON

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

{
    "created_epoch": "1621814400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1621814400000",
    "number": "1184299018",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "311 PRINCETON RD STE 1",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "376012080",
            "telephone_number": "423-278-1856",
            "fax_number": "423-390-6945"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "438 E VANN RD STE 101",
            "city": "GREENEVILLE",
            "state": "TN",
            "postal_code": "377437202",
            "telephone_number": "423-278-1856",
            "fax_number": "423-390-6945"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WELLMONT MEDICAL ASSOCIATES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-05-24",
        "last_updated": "2021-05-24",
        "certification_date": "2021-05-24",
        "status": "A",
        "authorized_official_last_name": "KRUTAK",
        "authorized_official_first_name": "MARY",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "EVP/CFO",
        "authorized_official_telephone_number": "423-302-3423"
    },
    "taxonomies": [
        {
            "code": "293D00000X",
            "taxonomy_group": "",
            "desc": "Physiological Laboratory",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Ballad Health Imaging Center, Greeneville",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Greeneville, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 24, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.