Basic Information
| Provider Information | |||||||||
| NPI: | 1174808216 | ||||||||
| 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: | 2020 BROOKSIDE DR | ||||||||
| Address2: | |||||||||
| City: | KINGSPORT | ||||||||
| State: | TN | ||||||||
| PostalCode: | 376604633 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4233430434 | ||||||||
| FaxNumber: | 4233430435 | ||||||||
| Practice Location | |||||||||
| Address1: | 323 CLOVERLEAF SQ | ||||||||
| Address2: | #1 | ||||||||
| City: | BIG STONE GAP | ||||||||
| State: | VA | ||||||||
| PostalCode: | 242192760 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2765236715 | ||||||||
| FaxNumber: | 2765236719 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/20/2011 | ||||||||
| LastUpdateDate: | 10/28/2019 | ||||||||
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| AuthorizedOfficialLastName: | LOCKE | ||||||||
| AuthorizedOfficialFirstName: | CINDY | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | BILLING ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 4234087220 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | CPC, CCS-P, PCS | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.