MOUNTAIN STATES HEALTH ALLIANCE (NPI# 1720468200) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1720468200 |
| Entity Type | Organization |
| Organization Name | MOUNTAIN STATES HEALTH ALLIANCE |
| Other Organization Name | MOUNTAIN STATES REHABILITATION AT IPMC |
| Practice Address |
2204 Pavilion Dr Suite 115 Kingsport TN 37660-4657 |
| Mailing Address |
311 Princeton Rd Ste 1 Johnson City TN 37601-2026 |
| Practice Telephone | 4238576777 |
| Practice Fax Number | 4238576788 |
| Mailing Telephone | 4238576777 |
| Mailing Fax Number | 4238576788 |
| Enumeration Date | 2015-06-01 |
| Last Update Date | 2017-12-11 |
| Authorized Official Name | GREGORY LEE WILGOCKI (CORP DIRECTOR REIMBURSEMENT) |
| Authorized Official Telephone | 4234315794 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 282N00000X | General Acute Care Hospital | 134 | TN | Hospitals |
| Other Name | Type Code |
|---|---|
| Mountain States Rehabilitation at IPMC | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962998732 | Mountain States Health Alliance | Home Health | 312 Cummings St Ste A, Abingdon, VA 24210-3200 | 2018-07-05 |
| 1336635192 | Mountain States Health Alliance | Hospice, Inpatient | 312 Cummings St Ste B, Abingdon, VA 24210-3200 | 2018-07-05 |
| 1669902243 | Mountain States Health Alliance | Hospice Care, Community Based | 312 Hospital Dr Suite 1b, Clintwood, VA 24228 | 2017-06-15 |
| 1316476211 | Mountain States Health Alliance | Home Health | 312 Hospital Dr Suite 1a, Clintwood, VA 24228 | 2017-06-06 |
| 1073064333 | Mountain States Health Alliance | General Acute Care Hospital | 400 N St of Franklin Rd, Johnson City, TN 37604 | 2016-10-20 |
| 1245781954 | Mountain States Health Alliance | Family Medicine | 58 Carroll St Suite 3, Dept of Russell County Medical Center, Lebanon, VA 24266 | 2016-10-18 |
| 1316322555 | Mountain States Health Alliance | General Acute Care Hospital | 81 S Flanagan Avenue, Lebanon, VA 24266-4515 | 2015-07-29 |
| 1619357928 | Mountain States Health Alliance | General Acute Care Hospital | 111 S Flannagan Avenue, Lebanon, VA 24266-4515 | 2015-06-02 |
| 1700054095 | Mountain States Health Alliance | Psychiatry & Neurology | 58 Carroll Steet, Lebanon, VA 24266 | 2008-02-20 |
| 1609054733 | Mountain States Health Alliance | Clinic/Center | 16431 Wise Street, Saint Paul, VA 24283-3537 | 2008-01-31 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| North Carolina Corporations | Mountain States Health Alliance | 160 Mine Lake Ct Ste 200, Raleigh, NC 27615 |
| Virginia Business Entities | Mountain States Health Alliance | 400 N State of Franklin Rd, Johnson City, Tennessee 37604 |
| Street Address |
2204 PAVILION DR SUITE 115 |
| City | KINGSPORT |
| State | TN |
| Zip Code | 37660-4657 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245226737 | Rebecca Jane Hamilton | Nurse Practitioner | 2204 Pavilion Dr, Suite 108, Kingsport, TN 37660-4657 | 2005-09-21 |
| 1821402728 | Sullivan Specialty Pharmacy | Pharmacy | 2204 Pavilion Dr, Suite 105, Kingsport, TN 37660-4657 | 2014-06-18 |
| 1568703437 | Lauren Musick | Pharmacist | 2204 Pavilion Dr, Suite 105, Kingsport, TN 37660-4657 | 2013-03-02 |
| 1316228075 | Clinchfield Family Medicine, Pllc | Clinic/Center | 2204 Pavilion Dr, Suite 110, Kingsport, TN 37660-4657 | 2011-09-07 |
| 1619265550 | Tennessee Anesthesiology LLC | Nurse Anesthetist, Certified Registered | 2204 Pavilion Dr, Suite 105, Kingsport, TN 37660-4657 | 2011-07-13 |
| 1396049938 | Blue Ridge Medical Management Corporation | Pediatrics | 2204 Pavilion Dr, Suite 210, Kingsport, TN 37660-4657 | 2010-12-22 |
| 1730401209 | Blue Ridge Medical Management Corporation | Family Medicine | 2204 Pavilion Dr, Suite 310, Kingsport, TN 37660-4653 | 2010-02-24 |
| 1518289206 | James Bradley Gaither | Nurse Anesthetist, Certified Registered | 2204 Pavilion Dr, Suite 105, Kingsport, TN 37660-4657 | 2010-02-22 |
| 1265763668 | Lauren Ambrosia Daley | Nurse Practitioner | 2204 Pavilion Dr, Suite 108, Kingsport, TN 37660-4657 | 2010-01-25 |
| 1902088644 | James W Denham | Pathology | 2204 Pavilion Dr, Kingsport, TN 37660-4657 | 2007-12-05 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1750909891 | Nancy Gober | Pharmacist | Holston Valley Medical Center Inpatient Pharmacy, 130 W Ravine, Kingsport, TN 37660 | 2020-07-06 |
| 1700437621 | Tammy Denise Leblanc | Technician | 125 Lancer Rd, Kingsport, TN 37660 | 2019-09-23 |
| 1831743392 | Independent Physical Therapy | Occupational Therapist | 1704 E. Stone Dr. Ste 120, Kingsport, TN 37660 | 2019-08-01 |
| 1871095315 | Macie Anderson | Nurse Practitioner | 411 Clay St, Kingsport, TN 37660 | 2018-03-01 |
| 1053813527 | Pulitzer Orthodontics, LLC | Dentist | 1200 Pulitzer Place, Kingsport, TN 37660 | 2018-03-01 |
| 1174038749 | Sbh-kingsport | Psychiatric Hospital | 1025 Executive Park Blvd, Kingsport, TN 37660 | 2017-12-05 |
| 1548771447 | Sara B Ball | Registered Nurse | 111 W Stone Dr Ste 240, Kingsport, TN 37660 | 2017-10-18 |
| 1821525361 | Ashley Brook Weems | Nurse Practitioner | Six Sheridan Square Suite 100, Kingsport, TN 37660 | 2017-05-15 |
| 1639625643 | Stephanie H Garris | Nurse Practitioner | 117 W Sevier Ave Ste 120, Kingsport, TN 37660 | 2016-08-30 |
| 1073965679 | Teresa Anne Starke | Physician Assistant | 8 Sheridan Square, Suite 110, Kingsport, TN 37660 | 2016-07-07 |
| Find all providers in zip 37660 | ||||
| Taxonomy Code | 282N00000X |
| Grouping | Hospitals |
| Classification | General Acute Care Hospital |
| An acute general hospital is an institution whose primary function is to provide inpatient diagnostic and therapeutic services for a variety of medical conditions, both surgical and non-surgical, to a wide population group. The hospital treats patients in an acute phase of illness or injury, characterized by a single episode or a fairly short duration, from which the patient returns to his or her normal or previous level of activity. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053674655 | Wellmont Integrated Network | General Acute Care Hospital | 1905 American Way, Kingsport, TN 37660-5882 | 2012-06-19 |
| 1992813240 | Mountain States Health Alliance | General Acute Care Hospital | 2000 Brookside Dr, Kingsport, TN 37660-4627 | 2006-08-28 |
| 1487690400 | Wellmont Health System | General Acute Care Hospital | 130 W Ravine Rd, Kingsport, TN 37660 | 2006-06-20 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174033906 | Behavioral Health of Rocky Top, LLC | General Acute Care Hospital | 210 Industrial Park Dr, Rocky Top, TN 37769-2301 | 2017-10-06 |
| 1104290667 | Michelle Mcconnell Spradley | General Acute Care Hospital | 5006 Dell Dr, Mount Juliet, TN 37122-4157 | 2015-11-20 |
| 1215301981 | Cheryl Hall Wideman | General Acute Care Hospital | 3721 Russell Hurst Dr E, Bartlett, TN 38135-1965 | 2015-11-18 |
| 1104206135 | Vanderbilt University | General Acute Care Hospital | 62 Parks Ln, Fayetteville, TN 37334-6642 | 2015-06-04 |
| 1306247515 | Fort Sanders Regional Medical Center | General Acute Care Hospital | 614 Emory Oak Ct, Knoxville, TN 37909-3439 | 2014-09-07 |
| 1740609130 | Select Specialty | General Acute Care Hospital | 2000 Hayes St Ste 1502, Nashville, TN 37203-2318 | 2014-04-14 |
| 1710301320 | Veronica Blackman | General Acute Care Hospital | 447 Shelley Renee Ln, Cordova, TN 38018-4310 | 2014-02-18 |
| 1962826107 | Hoke Steven Fitzgerald | General Acute Care Hospital | 1073 Smithfield Rd, Tellico Plains, TN 37385-6137 | 2014-02-07 |
| 1336560598 | Vanderbilt University Medical Center | General Acute Care Hospital | 607 Medical Arts Building, 1121 21st Avenue South, Nashville, TN 37232-1320 | 2013-12-13 |
| 1710314554 | Centennial | General Acute Care Hospital | 552 Metroplex Dr, Nashville, TN 37211-3133 | 2013-10-10 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.