MOUNTAIN STATES HEALTH ALLIANCE (NPI# 1891973939) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1891973939 |
| Entity Type | Organization |
| Organization Name | MOUNTAIN STATES HEALTH ALLIANCE |
| Other Organization Name | RUSSELL COUNTY HOSPITAL |
| Practice Address |
58 Carroll St Lebanon VA 24266-4515 |
| 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 | 2008-01-31 |
| Last Update Date | 2019-01-28 |
| 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 | 282N00000X | General Acute Care Hospital | VA | Hospitals |
| Other Name | Type Code |
|---|---|
| Russell County Hospital | 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 |
58 CARROLL ST |
| City | LEBANON |
| State | VA |
| Zip Code | 24266-4515 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962401448 | John Martin Kerr | Surgery | 58 Carroll St, Suite 2d, Lebanon, VA 24266 | 2005-07-18 |
| 1306376108 | Sasha Musick | Nurse Practitioner | 58 Carroll St, Room 2037, Lebanon, VA 24266 | 2017-06-14 |
| 1073990248 | Blue Ridge Medical Managment Corporation | Internal Medicine | 58 Carroll St, Room 2037, Lebanon, VA 24266 | 2015-04-27 |
| 1053719450 | Tara Dalton | Pharmacist | 58 Carroll St, Lebanon, VA 24266 | 2014-12-17 |
| 1841694486 | Amanda Hansen | Nurse Practitioner | 58 Carroll St, Room 2037, Lebanon, VA 24266 | 2014-10-10 |
| 1104158054 | Mountain States Health Alliance | Radiology | 58 Carroll St, Lebanon, VA 24266-3600 | 2010-02-03 |
| 1568649697 | Mountain States Health Alliance | Psychiatric Unit | 58 Carroll St, Lebanon, VA 24266-4510 | 2008-01-31 |
| 1861670903 | Mountain States Health Alliance | Medicare Defined Swing Bed Unit | 58 Carroll St, Lebanon, VA 24266-4510 | 2008-01-31 |
| 1528249133 | Jenny M Pruitt | Physician Assistant | 58 Carroll St, Room 2037, Lebanon, VA 24266 | 2007-11-26 |
| 1699724013 | David M Mitchell | Internal Medicine | 58 Carroll St, Room 2037, Lebanon, VA 24266 | 2006-05-10 |
| Find all providers in the same location | ||||
| 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 | 282N00000X |
| Grouping | Hospitals |
| Classification | General Acute Care Hospital |
| An acute general hospital is an institution whose primary function is to provide inpatient diagnostic and therapeutic services for a variety of medical conditions, both surgical and non-surgical, to a wide population group. The hospital treats patients in an acute phase of illness or injury, characterized by a single episode or a fairly short duration, from which the patient returns to his or her normal or previous level of activity. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 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 |
| 1295163293 | Good Samaritan Hospital | General Acute Care Hospital | 4th and Walnut St., Good Samaritan Hospital, Lebanon, PA 17042-9171 | 2013-10-29 |
| 1306889597 | Vanderbilt University Medical Center | General Acute Care Hospital | 1411 W. Baddour Parkway, Lebanon, TN 37087-2513 | 2006-06-14 |
| 1922003730 | Russell County Medical Center, Inc | General Acute Care Hospital | 58 Carroll Street, Lebanon, VA 24266 | 2005-06-17 |
| 1023672821 | Vanderbilt University Medical Center | General Acute Care Hospital | 1411 W Baddour Pkwy, Lebanon, TN 37087-2513 | 2019-04-26 |
| 1215397633 | Dartmouth-hitchcock Medical Center | General Acute Care Hospital | 1 Medical Center Dr, Lebanon, NH 03756-1000 | 2016-02-26 |
| 1194030395 | Dartmouth Hitchcock Psychiatric Associates | General Acute Care Hospital | 1 Medical Center Dr, 5d, Lebanon, NH 03756-1000 | 2010-08-11 |
| 1861613036 | Witham Memorial Hospital | General Acute Care Hospital | 2605 N Lebanon St, Lebanon, IN 46052-1476 | 2007-05-02 |
| 1407928500 | The Good Samaritan Hospital | General Acute Care Hospital | 252 S 4th St, Lebanon, PA 17042-6111 | 2006-11-14 |
| 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.