Provider Demographics
NPI:1174553598
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: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:423-921-7000
Mailing Address - Fax:423-921-7022
Practice Address - Street 1:851 LOCUST ST
Practice Address - Street 2:
Practice Address - City:ROGERSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37857
Practice Address - Country:US
Practice Address - Phone:423-921-7000
Practice Address - Fax:423-921-7022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-03
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0440032Medicaid
TN100020080Medicaid
TNA3785700Medicaid
TN030023800OtherBLACK LUNG
TN1000804OtherTN BLUE CROSS
VA004400356Medicaid
VA158031OtherANTHEM
TN1000804Medicaid
TNA3785700OtherUHC RIVER VALLEY
TN030023800OtherBLACK LUNG