Organization
WELLMONT CARDIOLOGY SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JUANITA L HARWOOD (DIRECTOR, ISHN NETWORK MANAGEMENT)
(423) 302-6565
Entity
Organization
Contact information
Practice address
2050 MEADOWVIEW PARKWAY, KINGSPORT, TN 37660-7332
(423) 230-5000
(423) 230-5097
Mailing address
2050 MEADOWVIEW PKWY, KINGSPORT, TN 37660-7475
(423) 230-5000
(423) 230-5035
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
—
—
207RI0011X
Interventional Cardiology Physician
—
—
2086S0129X
Vascular Surgery Physician
—
—
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
—
—
363AM0700X
Medical Physician Assistant
—
—
363AS0400X
Surgical Physician Assistant
—
—
363L00000X
Nurse Practitioner
—
—
363LA2100X
Acute Care Nurse Practitioner
—
—
363LA2200X
Adult Health Nurse Practitioner
—
—
363LF0000X
Family Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1376575035
—
VA
05
—
3382170
—
TN
05
—
3382171
—
TN
01
—
DR5963
RAILROAD MEDICARE
TN
01
—
DR8098
RAILROAD MEDICARE
VA
Enumeration date
07/06/2006
Last updated
04/22/2024
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