Organization
MOUNTAIN STATES HEALTH ALLIANCE
Active
Other names
Indian Path Community Hospital
Organization subpart
No
Provider details
NPI number
Authorized official
SHANE EDWIN HILTON (EVP/CFO)
(423) 302-3467
Entity
Organization
Contact information
Practice address
2000 BROOKSIDE DR, KINGSPORT, TN 37660-4627
(423) 857-7000
(423) 857-7078
Mailing address
311 PRINCETON RD STE 1, JOHNSON CITY, TN 37601-2026
(423) 857-7000
(423) 857-7078
Taxonomy
Speciality
Code
Description
License number
State
282N00000X
General Acute Care Hospital
Primary
0000000134
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000127730
—
SC
05
—
000363855X
—
GA
05
—
004401760
—
VA
05
—
00672239
—
MS
05
—
01600113
—
KY
01
—
030138700
BLACK LUNG
—
05
—
0440176
—
TN
05
—
091618800
—
FL
05
—
0938025
—
OH
01
—
1000807
BLUE CROSS
—
01
—
17505000
MAGELLAN
—
01
—
226529
ANTHEM
—
01
—
3457347
CIGNA
—
05
—
4400176
—
NC
05
—
4699873
—
MI
05
—
4699882
—
MI
01
—
A3766020
JOHN DEERE
—
Enumeration date
08/28/2006
Last updated
04/16/2024
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