NPIMap

Organization Active NPI

Wellmont Health System

Doing business as Bristol Hospice House

  • Inpatient Hospice
  • Bristol, TN
National Provider Identifier
1962432088
Registry record updated Sep 4, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Inpatient HospiceTaxonomy code 315D00000X
Legal business name
WELLMONT HEALTH SYSTEM
Doing business as
Bristol Hospice House
Practice address
280 Steeles Rd
Bristol, TN 37620
Phone
(423) 844-5252
Fax
(423) 844-6379
NPI assigned
Jul 4, 2006
Last updated
Sep 4, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 4, 2018

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

Authorized official

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Inpatient Hospice 315D00000X Primary

Addresses

Primary practice location

280 Steeles Rd
Bristol, TN 37620

Mailing address

311 Princeton Rd Ste 1
Johnson City, TN 37601-2026
Phone (423) 844-5252

Other names 1

  • BRISTOL HOSPICE HOUSE Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Ownership & related parties

Change-of-ownership history 1

DateEventCounterparty
Jul 1, 2018 Change of OwnershipThis provider was the seller Ballad Health HospiceCCN 441558, TN, NPI 1033605886

Change of ownership 1

Medicare changes of ownership in which this facility was the buyer or the seller.

NPI Registry JSON

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

{
    "created_epoch": "1151971200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1536019200000",
    "number": "1962432088",
    "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": "376012026",
            "telephone_number": "423-844-5252",
            "fax_number": "423-844-6379"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "280 STEELES RD",
            "city": "BRISTOL",
            "state": "TN",
            "postal_code": "37620",
            "telephone_number": "423-844-5252",
            "fax_number": "423-844-6379"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WELLMONT HEALTH SYSTEM",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-04",
        "last_updated": "2018-09-04",
        "status": "A",
        "authorized_official_last_name": "KRUTAK",
        "authorized_official_first_name": "MARY",
        "authorized_official_middle_name": "LYNN",
        "authorized_official_title_or_position": "EVP/CFO",
        "authorized_official_telephone_number": "423-302-3423"
    },
    "taxonomies": [
        {
            "code": "315D00000X",
            "taxonomy_group": "",
            "desc": "Hospice, Inpatient",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "BRISTOL HOSPICE HOUSE",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "BRISTOL HOSPICE HOUSE",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bristol, TN

Sources for this page

Verify at the official NPI Registry.