Organization
MOUNTAIN STATES HEALTH ALLIANCE
Active
Other names
Johnson City Specialty Hospital
Organization subpart
No
Provider details
NPI number
Authorized official
MARVIN H EICHORN (SVP/CFO)
(423) 431-6111
Entity
Organization
Contact information
Practice address
203 E WATAUGA AVE, JOHNSON CITY, TN 37601-4629
(423) 926-1111
(423) 979-6163
Mailing address
203 E WATAUGA AVE, JOHNSON CITY, TN 37601-4629
(423) 926-1111
(423) 979-6163
Taxonomy
Speciality
Code
Description
License number
State
282N00000X
General Acute Care Hospital
Primary
0000000122
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004401051
—
VA
05
—
01600964
—
KY
05
—
0440105
—
TN
01
—
0700245
CIGNA
—
05
—
091618800
—
FL
01
—
100020074
PHP
—
01
—
1000373
BLUE CROSS
—
01
—
437727
ANTHEM
—
05
—
4400105
—
NC
01
—
A3760124
JOHN DEERE
—
Enumeration date
08/31/2006
Last updated
08/12/2008
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