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
1990 HOLTON AVE E, BIG STONE GAP, VA 24219-3350
(423) 224-3250
(423) 224-3257
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
—
—
207RC0000X
Cardiovascular Disease Physician
—
—
207RH0003X
Hematology & Oncology Physician
—
—
207RP1001X
Pulmonary Disease Physician
—
—
207V00000X
Obstetrics & Gynecology Physician
—
—
207VG0400X
Gynecology Physician
—
—
207X00000X
Orthopaedic Surgery Physician
—
—
208000000X
Pediatrics Physician
—
—
208100000X
Physical Medicine & Rehabilitation Physician
—
—
208600000X
Surgery Physician
—
—
363A00000X
Physician Assistant
—
—
363L00000X
Nurse Practitioner
—
—
367500000X
Certified Registered Nurse Anesthetist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
023305008
FEDERAL BLACK LUNG
VA
05
—
6590412000
—
KY
05
—
6593109900
—
KY
05
—
6594222900
—
KY
05
—
7100034130
—
KY
Enumeration date
03/27/2007
Last updated
11/05/2010
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