Provider Demographics
NPI:1295193183
Name:WELLMONT MEDICAL ASSOCIATES, INC.
Entity Type:Organization
Organization Name:WELLMONT MEDICAL ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:WHS SR VP FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:TODD
Authorized Official - Middle Name:J
Authorized Official - Last Name:DOUGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-230-8512
Mailing Address - Street 1:509 MED TECH PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37604-2579
Mailing Address - Country:US
Mailing Address - Phone:423-952-2111
Mailing Address - Fax:423-952-2175
Practice Address - Street 1:410 STAGECOACH RD
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:VA
Practice Address - Zip Code:24201-8359
Practice Address - Country:US
Practice Address - Phone:276-466-0480
Practice Address - Fax:276-669-8583
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-05
Last Update Date:2019-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care