Organization
WELLMONT PHYSICIAN SERVICES INC
Active
Other names
Mendota Medical 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
2534 MENDOTA RD, MENDOTA, VA 24270-2018
(276) 645-6710
(276) 645-6712
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
—
1527279
UMWA
VA
05
—
4409966
—
TN
01
—
CC3164
RAIL ROAD MEDICARE
VA
Enumeration date
03/27/2007
Last updated
04/20/2008
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