Organization
MOUNTAIN STATES HEALTH ALLIANCE
Active
Organization
MOUNTAIN STATES HEALTH ALLIANCE
Active
Other names
BHMA Wound Care LCCH
Organization subpart
No
Provider details
NPI number
Authorized official
JUANITA L HARWOOD (DIRECTOR)
(423) 302-6565
Entity
Organization
Contact information
Practice address
127 HEALTH CARE DR, PENNINGTON GAP, VA 24277-2853
(276) 546-6492
(276) 546-6959
Mailing address
1021 W OAKLAND AVE STE 310, JOHNSON CITY, TN 37604-2192
(423) 302-6565
Taxonomy
Speciality
Code
Description
License number
State
163WW0000X
Wound Care Registered Nurse
Primary
—
—
207R00000X
Internal Medicine Physician
—
—
Other
Enumeration date
12/17/2024
Last updated
12/17/2024
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