# MOUNTAIN STATES HEALTH ALLIANCE

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Russell County Medical Center Anesthesiology Department
- **Organization subpart:** No

## Provider details

- **NPI number:** 1073782900
- **Authorized official:** MR. MARVIN H. EICHORN (SENIOR VICE PRESIDENT AND CFO)
- **Authorized official phone:** (423) 431-1017

## Contact information

- **Practice address:** 58 CARROLL STREET, LEBANON, VA 24266-4510
- **Practice address phone:** (276) 883-8000
- **Mailing address:** 58 CARROLL STREET, LEBANON, VA 24266-4510
- **Mailing address phone:** (276) 883-8000

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207L00000X | Anesthesiology Physician | H1892 | VA | Yes |

## Other

- **Enumeration date:** 02/25/2008
- **Last updated:** 02/25/2008