Organization
WELLMONT PHYSICIAN SERVICES INC
Active
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
1 MEDICAL PARK BLVD, SUITE 200E, BRISTOL, TN 37620-7430
(423) 844-5100
(423) 844-5109
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
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
023305000
FEDERAL BLACK LUNG
VA
01
—
1535526
UMWA
VA
Enumeration date
03/27/2007
Last updated
04/16/2010
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