Mountain States Health Alliance

LBN: Mountain States Health Alliance
Mountain States Health Alliance is an health care organization with primary practice located at 400 N State Of Franklin Rd Niswonger Children'S Hospital Admin, Johnson City TN 37604-6035. The organization recently has 3 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Pediatrics, Allopathic & Osteopathic Physicians / Pediatric Critical Care Medicine, Physician Assistants & Advanced Practice Nursing Providers / Pediatrics. Allopathic & Osteopathic Physicians / Pediatrics is the primary health care specialty. Mountain States Health Alliance can be contacted via phone (423) 431-4847, or through Krutak, Mary Lynn via phone (423) 302-3423.

Contact Information

Primary practice address
400 N State Of Franklin Rd Niswonger Children'S Hospital Admin Johnson City TN 37604-6035
Phone: (423) 431-4847
Fax: (423) 431-3949
Website:
Map and Directions
Authorized official contact:
Name: Krutak, Mary Lynn
Phone: (423) 302-3423

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Pediatrics 208000000X
Allopathic & Osteopathic Physicians / Pediatric Critical Care Medicine 2080P0203X
Physician Assistants & Advanced Practice Nursing Providers / Pediatrics 363LP0200X

Profile Details

NPI number 1124426259
LBN Legal business name Mountain States Health Alliance
DBA Doing business as
Authorized official Krutak, Mary Lynn
Entity Organization
Organization subpart 1 No
Enumeration date Dec 5th, 2014
Last updated Feb 26th, 2018 - about 6 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1124426259 NPPES
Tennessee MEDICAID Q010765

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