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
1980 HOLTON AVE E, BIG STONE GAP, VA 24219-3366
(276) 523-8741
(276) 523-8745
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
207Q00000X
Family Medicine Physician
Primary
—
—
207R00000X
Internal Medicine Physician
—
—
207RC0000X
Cardiovascular Disease Physician
—
—
208000000X
Pediatrics Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
023305000
FEDERAL BLACK LUNG
VA
01
—
1527279
UMWA
VA
05
—
65931099
—
KY
05
—
65942229
—
KY
Enumeration date
03/27/2007
Last updated
04/22/2010
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