Organization
MOUNTAIN STATES HEALTH ALLIANCE
Active
Other names
Sycamore Shoals Hospital
Organization subpart
No
Provider details
NPI number
Authorized official
SHANE EDWIN HILTON (EVP/CFO)
(423) 302-3467
Entity
Organization
Contact information
Practice address
1501 W ELK AVE, ELIZABETHTON, TN 37643-2874
(423) 542-1300
(423) 543-5372
Mailing address
311 PRINCETON RD STE 1, JOHNSON CITY, TN 37601-2026
(423) 542-1300
(423) 543-5372
Taxonomy
Speciality
Code
Description
License number
State
282N00000X
General Acute Care Hospital
Primary
0000000012
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004713038
—
GA
05
—
0440018
—
TN
05
—
06322734
—
MS
01
—
0699825
CIGNA
—
05
—
091618800
—
FL
01
—
100020104
PHP
—
01
—
1000224
BLUE CROSS
—
01
—
437730
ANTHEM
—
05
—
4400018
—
NC
05
—
4764327
—
MI
05
—
4764336
—
MI
01
—
A3764317
JOHN DEERE
—
05
—
SYC0018N
—
AL
Enumeration date
08/22/2006
Last updated
04/16/2024
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