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Organization

WELLMONT PHYSICIAN SERVICES INC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MRS. CINDY LOCKE CPC, CCS-P (BILLING ADMINISTRATOR)
(423) 224-3289
Entity
Organization

Contact information

Practice address
999 EXECUTIVE PARK BLVD, SUITE 201, KINGSPORT, TN 37660-4632
(423) 224-3250
(423) 224-3258
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
207L00000X
Anesthesiology Physician
207Q00000X
Family Medicine Physician
207R00000X
Internal Medicine Physician
Primary
207RH0003X
Hematology & Oncology Physician
207RI0200X
Infectious Disease Physician
207V00000X
Obstetrics & Gynecology Physician
207VM0101X
Maternal & Fetal Medicine Physician
207X00000X
Orthopaedic Surgery Physician
208000000X
Pediatrics Physician
363AM0700X
Medical Physician Assistant
363AS0400X
Surgical Physician Assistant
363L00000X
Nurse Practitioner
363LP0200X
Pediatric Nurse Practitioner
363LX0001X
Obstetrics & Gynecology Nurse Practitioner
367500000X
Certified Registered Nurse Anesthetist

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
1527279
UMWA
TN
01
23305008
FEDERAL BLACK LUNG
TN
05
3709584
TN
05
65931099
KY
Enumeration date
05/25/2006
Last updated
09/16/2010
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