Provider Demographics
NPI:1144437716
Name:WELLMONT HEALTH SYSTEM
Entity type:Organization
Organization Name:WELLMONT HEALTH SYSTEM
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:GREGORY
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:423-224-6900
Mailing Address - Street 1:2000 GREENWAY STREET
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37660
Mailing Address - Country:US
Mailing Address - Phone:423-224-6900
Mailing Address - Fax:423-224-3759
Practice Address - Street 1:2000 GREENWAY ST
Practice Address - Street 2:
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660-3020
Practice Address - Country:US
Practice Address - Phone:423-224-6900
Practice Address - Fax:423-224-3759
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-16
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNACL0000000155310400000X, 385H00000X
TNI-01261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNH445081Medicaid
TNV621P-3841OtherVETERANS AFFAIRS CONTRACT
TNV621P-3841OtherVETERANS AFFAIRS
TN100224722OtherS&U EXEMPT
TN627479657OtherDUNNS NUMBER