Organization
MOUNTAIN STATES HEALTH ALLIANCE
Active
Other names
Mountain States Rehabilitation at IPMC
Organization subpart
No
Provider details
NPI number
Authorized official
GREGORY LEE WILGOCKI (CORP DIRECTOR REIMBURSEMENT)
(423) 431-5794
Entity
Organization
Contact information
Practice address
2204 PAVILION DR, SUITE 115, KINGSPORT, TN 37660-4657
(423) 857-6777
(423) 857-6788
Mailing address
311 PRINCETON RD STE 1, JOHNSON CITY, TN 37601-2026
(423) 857-6777
(423) 857-6788
Taxonomy
Speciality
Code
Description
License number
State
282N00000X
General Acute Care Hospital
Primary
134
TN
Other
Enumeration date
06/01/2015
Last updated
12/11/2017
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