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Organization

MOUNTAIN STATES HEALTH ALLIANCE INDIAN PATH MEDICAL CENTER

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MR. DENNIE VONDERFECHT (CEO)
(423) 431-1009
Entity
Organization

Contact information

Practice address
400 N STATE OF FRANKLIN RD, MANAGED CARE ADMINISTRATION, JOHNSON CITY, TN 37604-6035
(423) 431-3548
(423) 431-3549
Mailing address
400 N STATE OF FRANKLIN RD, MANAGED CARE ADMINISTRATION, JOHNSON CITY, TN 37604-6035
(423) 431-3548
(423) 431-3549

Taxonomy

Speciality
Code
Description
License number
State
282N00000X
General Acute Care Hospital
Primary
0000000134
TN

Other

Enumeration date
12/20/2006
Last updated
08/22/2020
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