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General NPI Number Information
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NPI Number | 1861670903
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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 | 01/31/2008
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Last Update Date | 04/16/2024
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Provider Practice Location Address
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Address Line | 58 CARROLL ST
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City | LEBANON
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State | VA
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Zip | 24266-4510
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Country | US
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Telephone | 276-883-8000
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Fax | 276-883-8250
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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 | 276-883-8000
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Fax | 276-883-8250
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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 | 275N00000X
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Taxonomy Name | Medicare Defined Swing Bed Hospital Unit
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License Number |
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License Number State | VA
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