Provider Demographics
NPI:1801826912
Name:WELLMONT HEALTH SYSTEM
Entity Type:Organization
Organization Name:WELLMONT HEALTH SYSTEM
Other - Org Name:LONESOME PINE HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EVP/CFO
Authorized Official - Prefix:
Authorized Official - First Name:SHANE
Authorized Official - Middle Name:EDWIN
Authorized Official - Last Name:HILTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-302-3467
Mailing Address - Street 1:311 PRINCETON RD STE 1
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37601-2026
Mailing Address - Country:US
Mailing Address - Phone:276-523-3111
Mailing Address - Fax:
Practice Address - Street 1:1990 HOLTON AVE E
Practice Address - Street 2:
Practice Address - City:BIG STONE GAP
Practice Address - State:VA
Practice Address - Zip Code:24219
Practice Address - Country:US
Practice Address - Phone:276-523-3111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-04
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000064909OtherKY BLUE CROSS
VA281670OtherANTHEM
VA004901142Medicaid
TN033385600OtherBLACK LUNG
TN166592402OtherDEPT LABOR WORK COMP TN
TN3072953Medicaid
KY0166098400Medicaid
TNA2421917Medicaid
WV9810037000Medicaid
TNA2421917OtherUHC RIVER VALLEY
KY000000064909OtherKY BLUE CROSS