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
1	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1649578386
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOUNTAIN STATES HEALTH ALLIANCE

Provider Business Mailing Address
First Line	:	1 PROFESSIONAL PARK DR
Second Line	:	SUITE 21 ROOM C-17
City	:	JOHNSON CITY
State	:	TN
Zip	:	37604-6587
Country	:	US
Telephone Number	:	423-232-6900
Fax Number	:	423-232-6903

Provider Business Practice Location Address
First Line	:	1 PROFESSIONAL PARK DR
Second Line	:	SUITE 21 ROOM C-17
City	:	JOHNSON CITY
State	:	TN
Zip	:	37604-6587
Country	:	US
Telephone Number	:	423-232-6900
Fax Number	:	423-232-6903

Authorized Official
Title or Position	:	AVP
Name	:	GRACIELA PEREIRA
Credential	:
Telephone Number	:	423-431-7060

Provider Enumeration Date	:	03/04/2011
Last Update Date	:	03/04/2011

Similar Medicare Providers

1457353393 — CARMEN W GLEZER NP
Practice Location Address:

1 PROFESSIONAL PARK DR , SUITE 21
JOHNSON CITY, TN
37604-6587

Practice Phone: 423-928-5111
Practice Fax: 423-928-1174

1962473405 — CANCER OUTREACH ASSOCIATES OF TENNESSEE, P.C.
Practice Location Address:

1 PROFESSIONAL PARK DR , MCPP #1, SUITE 18
JOHNSON CITY, TN
37604-6587

Practice Phone: 423-926-0063
Practice Fax: 423-926-0073

1144241464 — KOYAMANGALATH KRISHNAN MD
Practice Location Address:

1 PROFESSIONAL PARK DR , STE 21
JOHNSON CITY, TN
37604-6587

Practice Phone: 423-232-6900
Practice Fax: 423-232-6903

1619039948 — MARY ANN CASH NP
Practice Location Address:

1 PROFESSIONAL PARK DR , SUITE 18
JOHNSON CITY, TN
37604-6587

Practice Phone: 276-676-1860
Practice Fax: 276-628-2917

1326178138 — MRS. MELANIE R. HARRISON PA-C
Practice Location Address:

1 PROFESSIONAL PARK DR , SUITE 21
JOHNSON CITY, TN
37604-6587

Practice Phone: 423-946-4163
Practice Fax: 423-232-6903

1275761538 — BLUE RIDGE MEDICAL MANAGEMENT CORPORATION
Practice Location Address:

1 PROFESSIONAL PARK DR , STE 21
JOHNSON CITY, TN
37604-6587

Practice Phone: 423-232-6900
Practice Fax: 423-232-6903

Directions to “MOUNTAIN STATES HEALTH ALLIANCE ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.