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General NPI Number Information
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NPI Number | 1386813616
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Entity Type | Organization
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Legal Business Name | MOUNTAIN STATES HEALTH ALLIANCE
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Dates
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Enumeration Date | 02/20/2008
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Last Update Date | 08/12/2024
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Provider Practice Location Address
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Address Line | 16431 WISE ST
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City | ST PAUL
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State | VA
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Zip | 24283
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Country | US
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Telephone | 276-762-2300
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Fax | 276-762-0612
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Provider Business Mailing Address
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Address Line | 1021 W OAKLAND AVE STE 310
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City | JOHNSON CITY
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State | TN
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Zip | 37604-2192
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Country | US
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Telephone | 423-302-6567
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Fax | 276-762-0612
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Authorized Official
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Title or Position | DIRECTOR
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Name | JUANITA HARWOOD
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Credential |
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Telephone | 423-392-6565
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number |
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License Number State |
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