NPIMap

Organization Active NPI

Wellmont Physician Services Inc

  • Internal Medicine Physician
  • Big Stone Gap, VA
National Provider Identifier
1619095403
Registry record updated Nov 5, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
WELLMONT PHYSICIAN SERVICES INC
Practice address
1990 Holton Ave E
Big Stone Gap, VA 24219-3350
Phone
(423) 224-3250
Fax
(423) 224-3257
NPI assigned
Mar 27, 2007
Last updated
Nov 5, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 5, 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 15

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X NU
Nurse Practitioner 363L00000X NU
Certified Registered Nurse Anesthetist 367500000X NU
Anesthesiology Physician 207L00000X NU
Family Medicine Physician 207Q00000X NU
Internal Medicine Physician 207R00000X NU Primary
Cardiovascular Disease Physician 207RC0000X NU
Hematology & Oncology Physician 207RH0003X NU
Pulmonary Disease Physician 207RP1001X NU
Obstetrics & Gynecology Physician 207V00000X NU
Gynecology Physician 207VG0400X NU
Orthopaedic Surgery Physician 207X00000X NU
Pediatrics Physician 208000000X NU
Physical Medicine & Rehabilitation Physician 208100000X NU
Surgery Physician 208600000X NU

Addresses

Primary practice location

1990 Holton Ave E
Big Stone Gap, VA 24219-3350

Mailing address

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

Other identifiers 5

IdentifierTypeStateIssuer
6594222900MedicaidKY
023305008OtherVAFEDERAL BLACK LUNG
6590412000MedicaidKY
6593109900MedicaidKY
7100034130MedicaidKY

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

109 Meadow View Rd
Ste 3
Bristol, TN 37620
Phone (423) 968-2446

438 E Vann Rd
Ste 301
Greeneville, TN 37743
Phone (423) 278-1650

111 W Stone Dr
Ste 300
Kingsport, TN 37660
Phone (423) 224-3150

130 W Ravine Rd
Ste 3A
Kingsport, TN 37660
Phone (423) 224-3220

132 W Sevier Ave
Ste 1
Kingsport, TN 37660
Phone (423) 224-3110

135 W Ravine Rd
Ste 8-A
Kingsport, TN 37660
Phone (423) 224-3210

146 W Park Dr
Ste 9D
Kingsport, TN 37660
Phone (423) 224-3450

146 W Park Dr
Ste 9I
Kingsport, TN 37660
Phone (423) 224-5699

2050 Meadowview Pkwy
Ste 205
Kingsport, TN 37660
Phone (423) 247-9075

2212 N John B Dennis Hwy
#D
Kingsport, TN 37660
Phone (423) 230-4255

405 S Armstrong Rd
Ste 5
Rogersville, TN 37857
Phone (423) 921-0880

330 Cummings St
Abingdon, VA 24210
Phone (540) 623-1717

391 Falls Dr NW
Abingdon, VA 24210
Phone (276) 628-4406

1 Cloverleaf Sq
#F1
Big Stone Gap, VA 24219
Phone (276) 523-6715

1980 Holton Ave E
#304
Big Stone Gap, VA 24219
Phone (276) 523-3111

1980 Holton Ave E
Ste 103
Big Stone Gap, VA 24219
Phone (276) 523-8865

1980 Holton Ave E
Ste 203
Big Stone Gap, VA 24219
Phone (276) 523-8681

157 Ross Carter Blvd
Duffield, VA 24244
Phone (276) 431-2841

1763 Park Ave SW
Norton, VA 24273
Phone (276) 679-1700

280 Virginia Ave NE
#4
Norton, VA 24273
Phone (540) 679-5880

601 Commonwealth Dr
Norton, VA 24273
Phone (276) 679-5880

127 Health Care Dr
#8
Pennington Gap, VA 24277
Phone (276) 546-3870

Practitioners & affiliated clinicians

Practitioners 158

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 158

NPI Registry JSON

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

{
    "created_epoch": "1174953600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1288915200000",
    "number": "1619095403",
    "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": "1990 HOLTON AVE E",
            "city": "BIG STONE GAP",
            "state": "VA",
            "postal_code": "242193350",
            "telephone_number": "423-224-3250",
            "fax_number": "423-224-3257"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WELLMONT PHYSICIAN SERVICES INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-27",
        "last_updated": "2010-11-05",
        "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": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207RH0003X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Hematology & Oncology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207RP1001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207VG0400X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology, Gynecology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6594222900",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FEDERAL BLACK LUNG",
            "identifier": "023305008",
            "state": "VA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6590412000",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6593109900",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100034130",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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 Nov 5, 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.