Basic Information
| Provider Information | |||||||||
| NPI: | 1154789030 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WELLMONT MEDICAL ASSOCIATES, INC. | ||||||||
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| OtherOrganizationName: | BALLAD HEALTH MEDICAL ASSOCIATES | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 105 W STONE DR | ||||||||
| Address2: | SUITE 6A | ||||||||
| City: | KINGSPORT | ||||||||
| State: | TN | ||||||||
| PostalCode: | 376603365 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4234087220 | ||||||||
| FaxNumber: | 4234087405 | ||||||||
| Practice Location | |||||||||
| Address1: | 378 MARKETPLACE DR | ||||||||
| Address2: | SUITE 5 | ||||||||
| City: | JOHNSON CITY | ||||||||
| State: | TN | ||||||||
| PostalCode: | 376042361 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4232820755 | ||||||||
| FaxNumber: | 4232821577 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/05/2016 | ||||||||
| LastUpdateDate: | 04/01/2019 | ||||||||
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| AuthorizedOfficialLastName: | DOUGAN | ||||||||
| AuthorizedOfficialFirstName: | TODD | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | WHS SR VP FINANCE | ||||||||
| AuthorizedOfficialTelephone: | 4232308512 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QU0200X | Y | Ambulatory Health Care Facilities | Clinic/Center | Urgent Care |
No ID Information.