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Organization
MOUNTAIN STATES HEALTH ALLIANCE
Active
Organization
MOUNTAIN STATES HEALTH ALLIANCE
Active
Other names
Sycamore Shoals Hospital Psychiatric Unit
Organization subpart
No
Provider details
NPI number
Authorized official
SHANE EDWIN HILTON (EVP/CFO)
(423) 302-3467
Entity
Organization
Contact information
Practice address
1501 W ELK AVE, ELIZABETHTON, TN 37643-2874
(423) 542-1300
(423) 543-5372
Mailing address
311 PRINCETON RD STE 1, JOHNSON CITY, TN 37601-2026
(423) 542-1300
(423) 543-5372
Taxonomy
Speciality
Code
Description
License number
State
273R00000X
Psychiatric Hospital Unit
Primary
0000000012
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
29725700
MAGELLAN
—
Enumeration date
08/31/2006
Last updated
04/16/2024
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