Provider Demographics
NPI:1124058615
Name:WELLMONT HEALTH SYSTEM
Entity type:Organization
Organization Name:WELLMONT HEALTH SYSTEM
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EVP/CFO
Authorized Official - Prefix:
Authorized Official - First Name:SHANE
Authorized Official - Middle Name:EDWIN
Authorized Official - Last Name:HILTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-302-3467
Mailing Address - Street 1:311 PRINCETON RD STE 1
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37601-2026
Mailing Address - Country:US
Mailing Address - Phone:423-844-1121
Mailing Address - Fax:
Practice Address - Street 1:1 MEDICAL PARK BLVD
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:TN
Practice Address - Zip Code:37620-7430
Practice Address - Country:US
Practice Address - Phone:423-844-1121
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-03
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN6530115OtherAETNA
VA004400127Medicaid
TN1377051OtherUMWA
VA240867OtherANTHEM
TNA3762106Medicaid
TN1000319OtherTN BLUE CROSS
SC10260BMedicaid
TNA3762106OtherUHC RIVER VALLEY
TN100020309Medicaid
TN033361400OtherBLACK LUNG
TN0440012Medicaid
TN166592403OtherPOSTAL WORKERS DEPT LAB
TN1000319OtherTN BLUE CROSS
TN1377051OtherUMWA
SC10260BMedicaid
SC10296AMedicaid
VA240867OtherANTHEM
TN0440012Medicaid
TN033361400OtherBLACK LUNG
TN1000319OtherTN BLUE CROSS