Organization
MOUNTAIN STATES HEALTH ALLIANCE
Active
Other names
Johnson City Medical Center
Organization subpart
No
Provider details
NPI number
Authorized official
SHANE EDWIN HILTON (EVP/CFO)
(423) 302-3467
Entity
Organization
Contact information
Practice address
400 N STATE OF FRANKLIN RD, JOHNSON CITY, TN 37604-6035
(423) 431-6111
(423) 431-3986
Mailing address
311 PRINCETON RD STE 1, JOHNSON CITY, TN 37601-2026
(423) 431-6111
(423) 431-3986
Taxonomy
Speciality
Code
Description
License number
State
273R00000X
Psychiatric Hospital Unit
0000000121
TN
282N00000X
General Acute Care Hospital
Primary
0000000121
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000262138X
—
GA
05
—
01620418
—
KY
05
—
01675483
—
NY
01
—
030283600
BLACK LUNG
—
05
—
0440063
—
TN
05
—
05431336
—
MS
05
—
0579913
—
OH
01
—
070026
CIGNA
—
05
—
091618800
—
FL
05
—
1749478
—
LA
05
—
42332
—
SC
05
—
4400063
—
NC
05
—
463496
—
SC
05
—
4688190
—
MI
05
—
4699882
—
MI
05
—
9802156000
—
WV
01
—
A3760501
JOHN DEERE
—
05
—
JOH0063N
—
AL
Enumeration date
09/07/2006
Last updated
04/16/2024
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