Organization
MOUNTAIN STATES HEALTH ALLIANCE
Active
Organization
MOUNTAIN STATES HEALTH ALLIANCE
Active
Other names
Ballad Health Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
SHANE HILTON (AO)
(423) 431-5794
Entity
Organization
Contact information
Practice address
523 N STATE OF FRANKLIN RD, JOHNSON CITY, TN 37604-8210
(423) 926-6154
(423) 926-5571
Mailing address
311 PRINCETON RD STE 1, JOHNSON CITY, TN 37601-2080
(423) 434-3101
(423) 431-1244
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
0000000490
TN
3336C0004X
Compounding Pharmacy
—
—
3336H0001X
Home Infusion Therapy Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2095601
PK
—
05
—
3516186
—
TN
Enumeration date
08/10/2006
Last updated
07/09/2026
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