Provider Demographics
NPI:1194752451
Name:WELLMONT HAWKINS COUNTY MEMORIAL HOSPITAL INC.
Entity type:Organization
Organization Name:WELLMONT HAWKINS COUNTY MEMORIAL HOSPITAL INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:MS
Authorized Official - First Name:ALICE
Authorized Official - Middle Name:
Authorized Official - Last Name:POPE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-230-8200
Mailing Address - Street 1:PO BOX 1089
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:TN
Mailing Address - Zip Code:37621-1089
Mailing Address - Country:US
Mailing Address - Phone:423-844-4500
Mailing Address - Fax:
Practice Address - Street 1:851 LOCUST ST
Practice Address - Street 2:
Practice Address - City:ROGERSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37857-2407
Practice Address - Country:US
Practice Address - Phone:423-921-7000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-26
Last Update Date:2011-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273R00000XHospital UnitsPsychiatric Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
44S032Medicare Oscar/Certification