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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
1273R00000XPsychiatric Hospital Unit000000121TN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
119558000OTHERMAGELLAN

General Provider Information

NPI Number : 1881797371
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 : 423-431-7111
Fax Number : 423-431-7301
Provider Business Practice Location Address
First Line : 403 N STATE OF FRANKLIN RD
Second Line :
City : JOHNSON CITY
State : TN
Zip : 37604-6034
Country : US
Telephone Number : 423-431-7111
Fax Number : 423-431-7301
Authorized Official
Title or Position : EVP/CFO
Name : SHANE EDWIN HILTON
Credential :
Telephone Number : 423-302-3467
Provider Enumeration Date : 09/07/2006
Last Update Date : 04/16/2024

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Directions to “MOUNTAIN STATES HEALTH ALLIANCE ” Practice Location

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