NPI 1053496901
Mountain States Health Alliance
Practice location
- Address
- 101 Med Tech Pkwy Suite 100, Johnson City, TN 37604-4007
- Phone
- (423) 431-4601
- Fax
- (423) 431-5733
- Mailing address
- 311 Princeton Rd STE 1, Johnson City, TN 37601-2026
Authorised official
- Name
- Mary Lynn Krutak
- Title
- Evp/Cfo
- Phone
- (423) 302-3423
Registered specialties (2)
Home Infusion Agency
Primary
Durable Medical Equipment & Medical Supplies
Registry record
- NPI
- 1053496901
- Entity type
- Organization
- NPI issued
- 26 Oct 2006
- Record last updated
- 29 Mar 2018
Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.