Provider Demographics
NPI:1275710063
Name:WELLMONT PHYSICIAN SERVICES INC
Entity Type:Organization
Organization Name:WELLMONT PHYSICIAN SERVICES INC
Other - Org Name:JENKINS SURGICAL ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING ADMINSTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CINDY
Authorized Official - Middle Name:M
Authorized Official - Last Name:LOCKE
Authorized Official - Suffix:
Authorized Official - Credentials:CPC, CCS-P
Authorized Official - Phone:423-224-3250
Mailing Address - Street 1:PO BOX 37024
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21297-3024
Mailing Address - Country:US
Mailing Address - Phone:423-224-3250
Mailing Address - Fax:423-224-3258
Practice Address - Street 1:9480 HIGHWAY 805
Practice Address - Street 2:
Practice Address - City:JENKINS
Practice Address - State:KY
Practice Address - Zip Code:41537-8182
Practice Address - Country:US
Practice Address - Phone:606-832-2172
Practice Address - Fax:606-832-9060
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-24
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty