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Organization
MOUNTAIN STATES HEALTH ALLIANCE
Active
Organization
MOUNTAIN STATES HEALTH ALLIANCE
Active
Other names
Indian Path Medical Center Transitional Care Unit
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MARY LYNN KRUTAK (SVP/CFO)
(423) 302-3774
Entity
Organization
Contact information
Practice address
2000 BROOKSIDE DR, KINGSPORT, TN 37660-4627
(423) 857-7000
(423) 857-7078
Mailing address
311 PRINCETON RD, JOHNSON CITY, TN 37601-2026
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
0000000336
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000127730
—
SC
05
—
000363855X
—
GA
05
—
004401760
—
VA
05
—
00672239
—
MS
05
—
01600113
—
KY
05
—
091618800
—
FL
05
—
0938025
—
OH
05
—
4400176
—
NC
05
—
4699873
—
MI
Enumeration date
09/07/2006
Last updated
10/30/2015
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