Organization
MOUNTAIN STATES HEALTH ALLIANCE
Active
Organization
MOUNTAIN STATES HEALTH ALLIANCE
Active
Other names
Medical Center Infusion Therapy
Organization subpart
No
Provider details
NPI number
Authorized official
MARY LYNN KRUTAK (EVP/CFO)
(423) 302-3423
Entity
Organization
Contact information
Practice address
101 MED TECH PKWY, SUITE 100, JOHNSON CITY, TN 37604-4007
(423) 431-4601
(423) 431-5733
Mailing address
311 PRINCETON RD STE 1, JOHNSON CITY, TN 37601-2026
(423) 431-4601
(423) 431-5733
Taxonomy
Speciality
Code
Description
License number
State
251F00000X
Home Infusion Agency
Primary
0000000434
TN
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
Other
Enumeration date
10/26/2006
Last updated
03/29/2018
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