# MOUNTAIN STATES HEALTH ALLIANCE

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Mountain States Rehabilitation at IPMC
- **Organization subpart:** No

## Provider details

- **NPI number:** 1720468200
- **Authorized official:** GREGORY LEE WILGOCKI (CORP DIRECTOR REIMBURSEMENT)
- **Authorized official phone:** (423) 431-5794

## Contact information

- **Practice address:** 2204 PAVILION DR, SUITE 115, KINGSPORT, TN 37660-4657
- **Practice address phone:** (423) 857-6777
- **Practice address fax:** (423) 857-6788
- **Mailing address:** 311 PRINCETON RD STE 1, JOHNSON CITY, TN 37601-2026
- **Mailing address phone:** (423) 857-6777
- **Mailing address fax:** (423) 857-6788

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 282N00000X | General Acute Care Hospital | 134 | TN | Yes |

## Other

- **Enumeration date:** 06/01/2015
- **Last updated:** 12/11/2017