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General NPI Number Information
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NPI Number | 1548376718
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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 | 08/21/2006
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Last Update Date | 02/21/2018
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Provider Practice Location Address
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Address Line | 509 MED TECH PKWY SUITE 200
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City | JOHNSON CITY
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State | TN
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Zip | 37604-2578
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Country | US
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Telephone | 423-431-6146
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Fax | 423-431-5733
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Provider Business Mailing Address
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Address Line | 311 PRINCETON RD SUITE 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 | 423-431-6146
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Fax | 423-431-5733
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Authorized Official
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Title or Position | EVP/CFO
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Name | MARY LYNN KRUTAK
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Credential |
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Telephone | 423-302-3423
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 0000000271
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License Number State | TN
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