Wellmont Outpatient Pharmacy
LBN: Medical Mall Pharmacy Inc
Wellmont Outpatient Pharmacy is an health care organization with primary practice located at 130 W Ravine Rd , Kingsport TN 37660-3837. The organization recently has 2 registered licenses in different health care specialties including Suppliers / Pharmacy, Suppliers / Community/Retail Pharmacy. Suppliers / Community/Retail Pharmacy is the primary health care specialty.
Medical Mall Pharmacy Inc can be contacted via phone (423) 224-6860, or through Hagee, Kristine via phone (423) 230-8432.
Contact Information
Primary practice address
130 W Ravine Rd
Kingsport TN 37660-3837
Phone: (423) 224-6860
Fax: (423) 224-5654
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Suppliers / Pharmacy | 333600000X | ||
| Suppliers / Community/Retail Pharmacy | 3336C0003X | C3413 | Tennessee |
Profile Details
| NPI number | 1275536997 |
|---|---|
| LBN Legal business name | Medical Mall Pharmacy Inc |
| DBA Doing business as | Wellmont Outpatient Pharmacy |
| Authorized official | Hagee, Kristine |
| Entity | Organization |
| Organization subpart 1 | No |
| Enumeration date | May 27th, 2005 |
| Last updated | Dec 3rd, 2009 - about 15 years ago |
1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1275536997 | NPPES |
| Tennessee | MEDICAID | 3130747 | |
| Tennessee | Other | 4433378 | |
| Tennessee | MEDICAID | 8517916 |
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