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General NPI Number Information
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NPI Number | 1497859789
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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 | 09/08/2006
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Last Update Date | 04/16/2024
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Provider Practice Location Address
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Address Line | 1901 S SHADY ST
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City | MOUNTAIN CITY
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State | TN
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Zip | 37683-2021
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Country | US
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Telephone | 423-727-1100
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Fax | 423-727-1112
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Provider Business Mailing Address
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Address Line | 311 PRINCETON RD STE 1
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City | JOHNSON CITY
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State | TN
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Zip | 37601-2026
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Country | US
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Telephone | 423-727-1100
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Fax | 423-727-1112
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Authorized Official
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Title or Position | EVP/CFO
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Name | SHANE EDWIN HILTON
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Credential |
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Telephone | 423-302-3467
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 282NC0060X
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Taxonomy Name | Critical Access Hospital
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License Number | 0000000038
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License Number State | TN
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