Provider Demographics
NPI:1487690400
Name:WELLMONT HEALTH SYSTEM
Entity type:Organization
Organization Name:WELLMONT HEALTH SYSTEM
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EVP/CFO
Authorized Official - Prefix:
Authorized Official - First Name:SHANE
Authorized Official - Middle Name:EDWIN
Authorized Official - Last Name:HILTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-302-3467
Mailing Address - Street 1:311 PRINCETON RD STE 1
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37601-2026
Mailing Address - Country:US
Mailing Address - Phone:423-224-4000
Mailing Address - Fax:
Practice Address - Street 1:130 W RAVINE RD
Practice Address - Street 2:
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660
Practice Address - Country:US
Practice Address - Phone:423-224-4000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-20
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0039640OtherUMWA OUT-PATIENT
VA240866OtherANTHEM BLUE CROSS
TN1000805Medicaid
NC4400017Medicaid
TN6530375OtherAETNA
TN0039632OtherUMWA IN-PATIENT
FL092263300Medicaid
TN166592401OtherPOSTAL WORKERS DEPT OF LA
LA1741825Medicaid
VA004400178Medicaid
WV0169767000Medicaid
TNA3766001OtherUHC RIVER VALLEY
TN036101100OtherBLACK LUNG
TN0440017Medicaid
TN100020304Medicaid
KY0162200000Medicaid
TN1000805OtherTN BLUE CROSS
TNA3766001Medicaid
WV0169767000Medicaid
TNA3766001OtherUHC RIVER VALLEY