MOUNTAIN STATES HEALTH ALLIANCE (NPI# 1053496901) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1053496901 |
| Entity Type | Organization |
| Organization Name | MOUNTAIN STATES HEALTH ALLIANCE |
| Other Organization Name | MEDICAL CENTER INFUSION THERAPY |
| Practice Address |
101 Med Tech Pkwy Suite 100 Johnson City TN 37604-4007 |
| Mailing Address |
311 Princeton Rd Ste 1 Johnson City TN 37601-2026 |
| Practice Telephone | 4234314601 |
| Practice Fax Number | 4234315733 |
| Mailing Telephone | 4234314601 |
| Mailing Fax Number | 4234315733 |
| Enumeration Date | 2006-10-26 |
| Last Update Date | 2018-03-29 |
| Authorized Official Name | MARY LYNN KRUTAK (EVP/CFO) |
| Authorized Official Telephone | 4233023423 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 332B00000X | Durable Medical Equipment & Medical Supplies | Suppliers | ||
| Y | 251F00000X | Home Infusion | 0000000434 | TN | Agencies |
| Other Name | Type Code |
|---|---|
| Medical Center Infusion Therapy | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962998732 | Mountain States Health Alliance | Home Health | 312 Cummings St Ste A, Abingdon, VA 24210-3200 | 2018-07-05 |
| 1336635192 | Mountain States Health Alliance | Hospice, Inpatient | 312 Cummings St Ste B, Abingdon, VA 24210-3200 | 2018-07-05 |
| 1669902243 | Mountain States Health Alliance | Hospice Care, Community Based | 312 Hospital Dr Suite 1b, Clintwood, VA 24228 | 2017-06-15 |
| 1316476211 | Mountain States Health Alliance | Home Health | 312 Hospital Dr Suite 1a, Clintwood, VA 24228 | 2017-06-06 |
| 1073064333 | Mountain States Health Alliance | General Acute Care Hospital | 400 N St of Franklin Rd, Johnson City, TN 37604 | 2016-10-20 |
| 1245781954 | Mountain States Health Alliance | Family Medicine | 58 Carroll St Suite 3, Dept of Russell County Medical Center, Lebanon, VA 24266 | 2016-10-18 |
| 1316322555 | Mountain States Health Alliance | General Acute Care Hospital | 81 S Flanagan Avenue, Lebanon, VA 24266-4515 | 2015-07-29 |
| 1619357928 | Mountain States Health Alliance | General Acute Care Hospital | 111 S Flannagan Avenue, Lebanon, VA 24266-4515 | 2015-06-02 |
| 1700054095 | Mountain States Health Alliance | Psychiatry & Neurology | 58 Carroll Steet, Lebanon, VA 24266 | 2008-02-20 |
| 1609054733 | Mountain States Health Alliance | Clinic/Center | 16431 Wise Street, Saint Paul, VA 24283-3537 | 2008-01-31 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| North Carolina Corporations | Mountain States Health Alliance | 160 Mine Lake Ct Ste 200, Raleigh, NC 27615 |
| Virginia Business Entities | Mountain States Health Alliance | 400 N State of Franklin Rd, Johnson City, Tennessee 37604 |
| Street Address |
101 MED TECH PKWY SUITE 100 |
| City | JOHNSON CITY |
| State | TN |
| Zip Code | 37604-4007 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205830536 | Fernando Bendfeldt | Psychiatry & Neurology | 101 Med Tech Pkwy, Ste 407, Johnson City, TN 37604-4000 | 2005-05-23 |
| 1558669986 | Caitlen M Petschke | Physician Assistant | 101 Med Tech Pkwy, Ste. 405, Johnson City, TN 37604-4007 | 2011-03-09 |
| 1023319290 | John Argerson | Specialist | 101 Med Tech Pkwy, Suite 402, Johnson City, TN 37604-4007 | 2010-11-04 |
| 1962655696 | Pain Medicine Associates, P.C. | Psychologist | 101 Med Tech Pkwy, Suite 200, Johnson City, TN 37604-4007 | 2008-10-28 |
| 1679722052 | Michael M Wilkinson | Anesthesiology | 101 Med Tech Pkwy, Johnson City, TN 37604-4007 | 2008-09-10 |
| 1548422355 | Pma Surgery Center LLC | Psychologist | 101 Med Tech Pkwy, Suite 205, Johnson City, TN 37604-4007 | 2008-07-02 |
| 1942475439 | Tri Cities Esthetics, Inc. | Specialist | 101 Med Tech Pkwy, Suite 402, Johnson City, TN 37604-4007 | 2008-04-25 |
| 1821158031 | Alison Repass Herrig | Nurse Practitioner | 101 Med Tech Pkwy, Suite 405, Johnson City, TN 37604-4007 | 2006-12-11 |
| 1417031071 | Smokie Mountain Dialysis Inc. | Clinic/Center | 101 Med Tech Pkwy, Suite 406, Johnson City, TN 37604-4007 | 2006-10-24 |
| 1922191238 | James A Ross | Emergency Medicine | 101 Med Tech Pkwy, Suite 305, Johnson City, TN 37604-4007 | 2006-10-02 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417560707 | Brant Logan Nickens | Physical Therapist | 809 Lamont St and Veterans Way, Johnson City, TN 37604 | 2020-08-26 |
| 1952911562 | David Sandlin Hobbs | Pharmacist | Lamont St &, Veterans Way, Johnson City, Tn 37604, Johnson City, TN 37604 | 2020-08-07 |
| 1528688272 | Whitney Marie Ward | Physical Therapist | Lamont Street and Veterans Way, Johnson City, TN 37604 | 2020-04-23 |
| 1861050015 | Akesh Thomas | Student in an Organized Health Care Education/Training Program | Johnson City Medical Center, 400 N State of Franklin Rd, Johnson City, TN 37604 | 2019-06-03 |
| 1336629021 | Medical Education Assistance Corporation | Clinic/Center | 820 W Market St, Johnson City, TN 37604 | 2018-08-21 |
| 1093208951 | Lauren Tiffany Hayden | Physician Assistant | 403 N State of Franklin Rd Woodridge Hospital, Johnson City, TN 37604 | 2018-06-14 |
| 1174014450 | Jerica Moore | Specialist/Technologist | 1041 Hamiltion Place Dr., Johnson City, TN 37604 | 2018-05-23 |
| 1053809442 | Syed Ghazanfar Hasan | Student in an Organized Health Care Education/Training Program | Etsu Psychiatry and Behavioral Sciences Department, 1276 Gilbreath Dr., Johnson City, TN 37604 | 2018-05-01 |
| 1699262485 | Sonia Kumari Oad | Student in an Organized Health Care Education/Training Program | 178 West Maple St, Johnson City, TN 37604 | 2018-04-17 |
| 1821519364 | Mahmoud El Iskandarani | Internal Medicine | 1084 W Oakland Avenue, 748, Johnson City, TN 37604 | 2017-07-06 |
| Find all providers in zip 37604 | ||||
| Taxonomy Code | 251F00000X |
| Grouping | Agencies |
| Classification | Home Infusion |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316545494 | Option Care Infusion Services, LLC | Home Infusion | 624 Grassmere Park Ste 22, Nashville, TN 37211-3671 | 2020-10-12 |
| 1700493087 | Infusion Partners, LLC | Home Infusion | 1680 Century Center Pkwy Ste 9, Memphis, TN 38134-8827 | 2020-09-30 |
| 1033726872 | Knoxville Home Therapies LLC | Home Infusion | 3201 Henson Rd Ste 101, Knoxville, TN 37921-5346 | 2020-09-25 |
| 1194348300 | Picc Infusion Care Company LLC | Home Infusion | 5 Park Ln, Hendersonville, TN 37075-9682 | 2020-05-21 |
| 1538524392 | Care Angles Home Health Care | Home Infusion | 676 Holland Ridge Dr, La Vergne, TN 37086-4266 | 2015-12-22 |
| 1740606847 | Clark Builders | Home Infusion | 860 Bear Creek Rd, Pinson, TN 38366-1955 | 2014-03-13 |
| 1477864031 | P3 Compounding, LLC | Home Infusion | 8848 Cedar Springs Ln, Suite 100, Knoxville, TN 37923-5415 | 2010-06-29 |
| 1811030331 | Caremax Pharmacy of Loudon, Inc | Home Infusion | 413 S Gay St Ste 203, Knoxville, TN 37902-1104 | 2007-02-14 |
| 1891868204 | Custom Healthcare | Home Infusion | 6227 Lee Highway, Suite I, Chattanooga, TN 37421 | 2006-11-15 |
| 1366432122 | Jackson-madison County General Hospital | Home Infusion | 1061 West Forest Avenue, Jackson, TN 38301-3879 | 2005-10-24 |
| Find all providers with the same taxonomy | ||||
| City | JOHNSON CITY |
| Zip Code | 37604 |
Please comment or provide details below to improve the information on MOUNTAIN STATES HEALTH ALLIANCE.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.