Organization
MOUNTAIN STATES HEALTH ALLIANCE
Active
Other names
BHRHC Mt. City, MSMG FP IM MTN
Organization subpart
No
Provider details
NPI number
Authorized official
DWAYNE TAYLOR (CEO)
(423) 542-1333
Entity
Organization
Contact information
Practice address
1901 S SHADY ST, MOUNTAIN CITY, TN 37683-2021
(423) 727-1100
(423) 727-1105
Mailing address
1901 S SHADY ST, MOUNTAIN CITY, TN 37683-2021
(423) 727-1100
(423) 727-1105
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
207R00000X
Internal Medicine Physician
—
—
261QR1300X
Rural Health Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3278673
—
TN
Enumeration date
08/09/2006
Last updated
08/12/2024
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