Provider Demographics
NPI:1982634440
Name:WELLMONT HEALTH SYSTEM, INC
Entity Type:Organization
Organization Name:WELLMONT HEALTH SYSTEM, INC
Other - Org Name:HOLSTON VALLEY MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP, FINANCE AND OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:ALICE
Authorized Official - Middle Name:
Authorized Official - Last Name:POPE
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:423-224-5263
Mailing Address - Street 1:551 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15901-2032
Mailing Address - Country:US
Mailing Address - Phone:814-539-5724
Mailing Address - Fax:814-536-7092
Practice Address - Street 1:130 W RAVINE RD
Practice Address - Street 2:
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37662
Practice Address - Country:US
Practice Address - Phone:423-224-4000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3257100Medicare ID - Type Unspecified