Provider Demographics
NPI:1104286194
Name:WELLMONT MEDICAL ASSOCIATES, INC.
Entity type:Organization
Organization Name:WELLMONT MEDICAL ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:WHS SR VP FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:TODD
Authorized Official - Middle Name:J
Authorized Official - Last Name:DOUGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-230-8512
Mailing Address - Street 1:105 W STONE DR
Mailing Address - Street 2:SUITE 6A
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37660-3365
Mailing Address - Country:US
Mailing Address - Phone:423-408-7220
Mailing Address - Fax:423-408-7405
Practice Address - Street 1:4485 W STONE DR
Practice Address - Street 2:SUITE 200
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660-1050
Practice Address - Country:US
Practice Address - Phone:423-224-3150
Practice Address - Fax:423-224-3169
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-03
Last Update Date:2016-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory