Organization
WELLMONT PHYSICIAN SERVICES INC
Active
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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