Organization
MOUNTAIN STATES HEALTH ALLIANCE
Active
Other names
Indian Path Medical Center Transitional Care Unit
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MARY LYNN KRUTAK (SVP/CFO)
(423) 302-3774
Entity
Organization
Contact information
Practice address
2000 BROOKSIDE DR, KINGSPORT, TN 37660-4627
(423) 857-7000
(423) 857-7078
Mailing address
311 PRINCETON RD, JOHNSON CITY, TN 37601-2026
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
0000000336
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000127730
—
SC
05
—
000363855X
—
GA
05
—
004401760
—
VA
05
—
00672239
—
MS
05
—
01600113
—
KY
05
—
091618800
—
FL
05
—
0938025
—
OH
05
—
4400176
—
NC
05
—
4699873
—
MI
Enumeration date
09/07/2006
Last updated
10/30/2015
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