NPIMap

Organization Active NPI

Wellmont Medical Associates, Inc.

  • Urgent Care Clinic/Center
  • Bristol, VA
National Provider Identifier
1295193183
Registry record updated Oct 18, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urgent Care Clinic/CenterTaxonomy code 261QU0200X
Legal business name
WELLMONT MEDICAL ASSOCIATES, INC.
Practice address
410 Stagecoach Rd
Bristol, VA 24201-8359
Phone
(276) 466-0480
Fax
(276) 669-8583
NPI assigned
Feb 5, 2016
Last updated
Oct 18, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 18, 2019

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

Authorized official

Name
Todd J Dougan
Title
WHS Sr VP Finance
Phone
(423) 230-8512

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Urgent Care Clinic/Center 261QU0200X NU Primary

Addresses

Primary practice location

410 Stagecoach Rd
Bristol, VA 24201-8359

Mailing address

509 Med Tech Pkwy Ste 100
Johnson City, TN 37604-2579
Phone (423) 952-2111

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120627000467 VA Part B Supplier - Clinic/Group Practice 8123291739 Receives reassigned benefits from 280 practitioners
4 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Norton, VA; Duffield, VA; Lebanon, VA; Marion, VA; Pennington Gap, VA; Weber City, VA; Wise, VA; Wytheville, VA…

Other NPIs on the same Medicare enrollment 4

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

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.

Practitioners & affiliated clinicians

Practitioners 17

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 17

NPI Registry JSON

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

{
    "created_epoch": "1454630400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1571356800000",
    "number": "1295193183",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "509 MED TECH PKWY STE 100",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "376042579",
            "telephone_number": "423-952-2111",
            "fax_number": "423-952-2175"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "410 STAGECOACH RD",
            "city": "BRISTOL",
            "state": "VA",
            "postal_code": "242018359",
            "telephone_number": "276-466-0480",
            "fax_number": "276-669-8583"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WELLMONT MEDICAL ASSOCIATES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-02-05",
        "last_updated": "2019-10-18",
        "status": "A",
        "authorized_official_last_name": "DOUGAN",
        "authorized_official_first_name": "TODD",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "WHS SR VP FINANCE",
        "authorized_official_telephone_number": "423-230-8512"
    },
    "taxonomies": [
        {
            "code": "261QU0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Urgent Care",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bristol, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 18, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.