NPIMap

Organization Active NPI

Wellmont Health System

  • Pharmacy
  • Bristol, VA
National Provider Identifier
1295313161
Registry record updated Apr 17, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacyTaxonomy code 333600000X
Legal business name
WELLMONT HEALTH SYSTEM
Practice address
743 Island Rd
Bristol, VA 24201-7403
Phone
(276) 469-4270
Fax
(423) 610-3364
NPI assigned
Mar 31, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 17, 2024

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

Authorized official

Name
Shane Edwin Hilton
Title
Evp/Cfo
Phone
(423) 302-3467

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X Primary
Specialty Pharmacy 3336S0011X

Addresses

Primary practice location

743 Island Rd
Bristol, VA 24201-7403

Mailing address

2 Professional Park Dr Ste 15
Johnson City, TN 37604-6584
Phone (423) 434-7443

Other identifiers 1

IdentifierTypeStateIssuer
0440012MedicaidTN

Other names 1

  • BH Specialty Pharmacy- BR Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Wllmnt Bristol PK Blvd25 organizations share this tax ID, including this one

Other organizations with this tax ID 24

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

View all 24

NPI Registry JSON

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

{
    "created_epoch": "1617148800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1713312000000",
    "number": "1295313161",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2 PROFESSIONAL PARK DR STE 15",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "376046584",
            "telephone_number": "423-434-7443",
            "fax_number": "423-302-3537"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "743 ISLAND RD",
            "city": "BRISTOL",
            "state": "VA",
            "postal_code": "242017403",
            "telephone_number": "276-469-4270",
            "fax_number": "423-610-3364"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WELLMONT HEALTH SYSTEM",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-03-31",
        "last_updated": "2024-04-17",
        "certification_date": "2024-04-17",
        "status": "A",
        "authorized_official_last_name": "HILTON",
        "authorized_official_first_name": "SHANE",
        "authorized_official_middle_name": "EDWIN",
        "authorized_official_title_or_position": "EVP/CFO",
        "authorized_official_telephone_number": "423-302-3467"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "3336S0011X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Specialty Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0440012",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "BH Specialty Pharmacy- BR",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "BH Specialty Pharmacy- BR",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Apr 17, 2024; 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.