Provider Demographics
NPI:1235146127
Name:WELLMONT HEALTH SYSTEM BRISTOL CRNA PROFESSIONAL GROUP
Entity Type:Organization
Organization Name:WELLMONT HEALTH SYSTEM BRISTOL CRNA PROFESSIONAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF CRNA
Authorized Official - Prefix:
Authorized Official - First Name:RENEE
Authorized Official - Middle Name:D
Authorized Official - Last Name:DIXON
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:423-968-4540
Mailing Address - Street 1:350 BLOUNTVILLE HWY
Mailing Address - Street 2:SUITE 207
Mailing Address - City:BRISTOL
Mailing Address - State:TN
Mailing Address - Zip Code:37620-0213
Mailing Address - Country:US
Mailing Address - Phone:423-968-4540
Mailing Address - Fax:423-968-5697
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:2006-08-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty