Indian Path Pavilion

LBN: Mountain States Health Alliance
Indian Path Pavilion is an health care organization with primary practice located at 2300 Pavilion Dr , Kingsport TN 37660-4622. The organization recently has only one registered license in Hospital Units / Psychiatric Unit, which is considered as the primary health care specialty. Mountain States Health Alliance can be contacted via phone (423) 857-5500, or through Krutak, Mary L via phone (423) 431-6111.

Contact Information

Primary practice address
2300 Pavilion Dr Kingsport TN 37660-4622
Phone: (423) 857-5500
Fax: (423) 857-7078
Website:
Map and Directions
Authorized official contact:
Name: Krutak, Mary L
Phone: (423) 431-6111

Health care specialties

SpecialtyCodeLicense #State
Hospital Units / Psychiatric Unit 273R00000X 0000000134 Tennessee

Profile Details

NPI number 1417050980
LBN Legal business name Mountain States Health Alliance
DBA Doing business as Indian Path Pavilion
Authorized official Krutak, Mary L
Entity Organization
Organization subpart 1 No
Enumeration date Sep 7th, 2006
Last updated Oct 15th, 2015 - about 9 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 1417050980 NPPES
Michigan MEDICAID 4699873
Michigan MEDICAID 000363855X
Michigan MEDICAID 004401760
Michigan MEDICAID 01600113
Michigan MEDICAID 091618800
Michigan MEDICAID 0938025
Michigan Other 17505000
Michigan MEDICAID 000127730
Michigan MEDICAID 00672239
Michigan MEDICAID 4400176

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