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Organization
WELLMONT PHYSICIAN SERVICES INC
Active
Organization
WELLMONT PHYSICIAN SERVICES INC
Active
Other names
Southwest VA Regional Cancer Center
Organization subpart
No
Provider details
NPI number
Authorized official
CINDY M LOCKE CPC CCS-P (BILLING ADMINISTRATOR)
(423) 224-3250
Entity
Organization
Contact information
Practice address
611 TRENT ST NE, NORTON, VA 24273-1533
(276) 679-5874
(276) 679-6912
Mailing address
999 EXECUTIVE PARK BLVD, SUITE 201, KINGSPORT, TN 37660-4632
(423) 224-3250
(423) 224-3258
Taxonomy
Speciality
Code
Description
License number
State
207RH0003X
Hematology & Oncology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
023305000
FEDERAL BLACK LUNG
VA
01
—
1008035
UMWA
VA
01
—
109871003
DMERC
VA
05
—
65931099
—
KY
Enumeration date
03/27/2007
Last updated
04/22/2010
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