MOUNTAIN STATES HEALTH ALLIANCE (NPI# 1871761726) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1871761726 |
| Entity Type | Organization |
| Organization Name | MOUNTAIN STATES HEALTH ALLIANCE |
| Practice Address |
58 Carroll Street Lebanon VA 24266-4510 |
| Mailing Address |
311 Princeton Rd Ste 1 Johnson City TN 37601-2026 |
| Practice Telephone | 2768838000 |
| Practice Fax Number | 2768838250 |
| Mailing Telephone | 2768838000 |
| Mailing Fax Number | 2768838250 |
| Enumeration Date | 2008-02-13 |
| Last Update Date | 2018-03-14 |
| 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 |
|---|---|---|---|---|---|
| Y | 207P00000X | Emergency Medicine | H1892 | VA | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| VA | 1922003730 | 05 |
| 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 |
58 CARROLL STREET |
| City | LEBANON |
| State | VA |
| Zip Code | 24266-4510 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1922003730 | Russell County Medical Center, Inc | General Acute Care Hospital | 58 Carroll Street, Lebanon, VA 24266 | 2005-06-17 |
| 1104321405 | Amanda Elizabeth Loughlin | Nurse Practitioner | 58 Carroll Street, Lebanon, VA 24266 | 2018-03-28 |
| 1659897569 | Ashley Jane Jenkins | Nurse Practitioner | 58 Carroll Street, Suite 4, Lebanon, VA 24266 | 2017-08-22 |
| 1689043952 | Kelsey Wise Mccoy | Physician Assistant | 58 Carroll Street, Lebanon, VA 24266 | 2015-09-17 |
| 1790167351 | Blue Ridge Medical Management | Surgery | 58 Carroll Street, Suite 2d, Lebanon, VA 24266 | 2015-06-19 |
| 1407282098 | Meeradevi Sudarsanan | Nurse Practitioner | 58 Carroll Street, Suite 2, Lebanon, VA 24266 | 2013-09-16 |
| 1750690087 | Appalachian Emergency Physicians | Emergency Medicine | 58 Carroll Street, Lebanon, VA 24266-0001 | 2010-10-05 |
| 1437462025 | Blue Ridge Medical Management Corporation | Surgery | 58 Carroll Street, Ste 2, Lebanon, VA 24266-0000 | 2010-07-23 |
| 1073782900 | Mountain States Health Alliance | Anesthesiology | 58 Carroll Street, Lebanon, VA 24266-4510 | 2008-02-25 |
| 1972771236 | Mountain States Health Alliance | Anesthesiology | 58 Carroll Street, Lebanon, VA 24266 | 2008-02-20 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1114541174 | Nextdoor Drug | Pharmacist | 932 W Main St, Lebanon, VA 24266 | 2020-06-04 |
| 1720638661 | Advanced Practice Primary Care, Pllc | Nurse Practitioner | 2336 Coal Tipple Hollow, Lebanon, VA 24266 | 2019-09-12 |
| 1962051763 | Best Life Physical Therapy Inc. | Physical Therapist | 383 Technology Park Drive, Lebanon, VA 24266 | 2019-09-05 |
| 1093361024 | Alexis Rae Carson | Psychologist | 84 Dr Lorraine C. Turner Dr. Russell County Public Scho, Lebanon, VA 24266 | 2019-08-15 |
| 1457821019 | Blue Ridge Medical Management Corporation | Internal Medicine | 71 S Flannagan Ave Suite 81, Lebanon, VA 24266 | 2018-11-27 |
| 1457867202 | Elizabeth Altizer Baker | Speech-Language Pathologist | 84 Lorraine C. Turner Dr., Russell County Public Schools, Lebanon, VA 24266 | 2017-12-15 |
| 1851805683 | Laura Hankins Vencill | Speech-Language Pathologist | Russell County Public Schools, 84 Lorraine C. Turner Dr., Lebanon, VA 24266 | 2017-12-01 |
| 1487168670 | Stacy Nichole Davis | Counselor | 78 Rogers St, Lebanon, VA 24266 | 2017-11-27 |
| 1568976751 | Kelly Elizabeth Smith | Counselor | 216 Gilmer Street, Lebanon, VA 24266 | 2017-11-27 |
| 1659883312 | Sara K Poole | Occupational Therapist | 408 Fields Ave., Lebanon, VA 24266 | 2017-11-02 |
| Find all providers in zip 24266 | ||||
| Taxonomy Code | 207P00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Emergency Medicine |
| An emergency physician focuses on the immediate decision making and action necessary to prevent death or any further disability both in the pre-hospital setting by directing emergency medical technicians and in the emergency department. The emergency physician provides immediate recognition, evaluation, care, stabilization and disposition of a generally diversified population of adult and pediatric patients in response to acute illness and injury. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: mofified source] - Additional Resources: American Board of Emergency Medicine, 2007. http://www.abem.org/public/; American Osteopathic Board of Emergency Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Emergency Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Emergency Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316479496 | Sormeh Harounzadeh | Emergency Medicine | 65 On The Grn, Lebanon, PA 17042-9473 | 2017-03-29 |
| 1518252964 | Medexpress Urgent Care, PC - Pennyslvania | Emergency Medicine | 1010 W Crestview Dr, Lebanon, PA 17042-7415 | 2011-06-14 |
| 1891929527 | James Michael Mcweeney | Emergency Medicine | 520 Mcclure Rd, Lebanon, OH 45036-9317 | 2009-05-09 |
| 1588762611 | Karl C Lewis | Emergency Medicine | 58 Carroll and Tate Streets, Call Box 3600, Lebanon, VA 24266 | 2006-09-20 |
| 1326141672 | Norman Rexrode Jr. | Emergency Medicine | 3600 Tate and Carroll Streets, Lebanon, VA 24266 | 2006-09-05 |
| 1316051683 | Scott P Giles | Emergency Medicine | 115 Winwood Dr Ste 205, Lebanon, TN 37087-1399 | 2006-08-17 |
| 1326064460 | Good Samaritan Physician Services | Emergency Medicine | 4th and Willow Streets, Lebanon, PA 17042-0300 | 2006-07-14 |
| 1265468169 | Russell Hal Mcune | Emergency Medicine | 35632 Brewster Rd, Lebanon, OR 97355-9452 | 2006-06-23 |
| 1639140585 | Karen L Oldham | Emergency Medicine | 2395 Cedar Grove Rd, Lebanon, TN 37087-7991 | 2006-01-30 |
| 1255328787 | Andrew Winge | Emergency Medicine | 525 N Santiam Hwy, Lebanon, OR 97355-4363 | 2005-09-30 |
| Find all providers in LEBANON | ||||
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| 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.