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
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—
Other
Enumeration date
10/26/2006
Last updated
03/29/2018
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