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1114033628

NPI Code Detail

MEDICARE: MOUNTAIN STATES HEALTH ALLIANCE

MEDICARE: MOUNTAIN STATES HEALTH ALLIANCE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	282N00000X	General Acute Care Hospital	0000000123	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	030508600	OTHER		BLACK LUNG
4	0700329	OTHER		CIGNA
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	1000381	OTHER		BLUE CROSS
8	A3760127	OTHER		JOHN DEERE
9	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
10	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
11	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
12	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
13	100020098	OTHER		PHP
14	437728	OTHER		ANTHEM
15	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1114033628
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOUNTAIN STATES HEALTH ALLIANCE

Provider Business Mailing Address
First Line	:	311 PRINCETON RD STE 1
Second Line	:
City	:	JOHNSON CITY
State	:	TN
Zip	:	37601-2026
Country	:	US
Telephone Number	:	423-302-1100
Fax Number	:	423-302-1129

Provider Business Practice Location Address
First Line	:	300 MED TECH PKWY
Second Line	:
City	:	JOHNSON CITY
State	:	TN
Zip	:	37604-2277
Country	:	US
Telephone Number	:	423-302-1100
Fax Number	:	423-302-1129

Authorized Official
Title or Position	:	EVP/CFO
Name	:	SHANE EDWIN HILTON
Credential	:
Telephone Number	:	423-302-3467

Provider Enumeration Date	:	08/21/2006
Last Update Date	:	04/16/2024

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1407056328 — MRS. ANGELA SEWELL RADER FNP
Practice Location Address:

300 MED TECH PKWY
JOHNSON CITY, TN
37604-2277

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1831492255 — APPALACHIAN EMERGENCY PHYSICIANS
Practice Location Address:

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Practice Fax:

1386926426 — BRIANNE AMACHER WILLIAMS PHARMD
Practice Location Address:

300 MED TECH PKWY , FRANKLIN WOODS COMMUNITY HOSPITAL PHARMACY
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Practice Fax:

1992075022 — ROLA MOUSA FRANKS PHARMD
Practice Location Address:

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1750725008 — JENNIFER LEIGH CANNON FNP
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Directions to “MOUNTAIN STATES HEALTH ALLIANCE ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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