Wellmont Health System, Inc
Organization Active NPI Emergency Medicine Physician · Kingsport, TN
NPI 1982634440 · NPPES record last updated Aug 22, 2020
Key facts
- NPI
- 1982634440
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Emergency Medicine Physician 207P00000X
- Legal business name
- WELLMONT HEALTH SYSTEM, INC
- Practice address
- 130 W Ravine Rd
Kingsport, TN 37662 - Phone
- (423) 224-4000
- NPI assigned
- Jul 3, 2006
- Organization subpart
- No
Authorized official
- Name
- Alice Pope, CPA
- Title
- VP, Finance and Operations
- Phone
- (423) 224-5263
Other NPIs on the same Medicare enrollment 5
Corporate family (same tax ID) 24
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 44D0028489 | Wellmont Health System | Accreditation | Aug 17, 2026 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TN
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20031223000853 | TN | Part B Supplier - Clinic/Group Practice | 2567360704 |
Receives reassigned benefits from 4 practitioners 5 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Bristol, TN; Kingsport, TN; Sneedville, TN |
National Provider Directory
- Tax ID family
- Wllmnt Bristol PK Blvd
Locations
551 Main St
Johnstown, PA 15901
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Emergency Medicine Physician |
207P00000X | Yes |
Addresses
Primary practice location
130 W Ravine Rd
Kingsport, TN 37662
Mailing address
551 Main St
Johnstown, PA 15901-2032
Phone (814) 539-5724
Other names
- Holston Valley Medical Center
Other providers in Kingsport, TN
- Wellmont Health System
- Wellmont Health System
- Wellmont Health System
- Wellmont Health System Cardiology Fees
- Wellmont Health System, Inc
- Wellmont Integrated Network
- Wellmont Medical Associates Inc
- Wellmont Medical Associates, Inc.
- Wellmont Medical Associates, Inc.
- Wellmont Physician Services Inc
All providers in Kingsport, TN · Emergency Medicine Physician in Tennessee
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 22, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.