Mountain States Health Alliance

Primary specialty

General Acute Care HospitalTaxonomy code 282N00000X

Legal business name

MOUNTAIN STATES HEALTH ALLIANCE

Practice address

2030 Temple Hill Rd
Erwin, TN 37650-8721

Phone

(423) 743-3141

Fax

(423) 743-1244

NPI assigned

Nov 5, 2013

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Shane Edwin Hilton

Title

Evp/Cfo

Phone

(423) 302-3467

Specialties & licenses 1

Addresses

Other names 1

• Unicoi County Hospital Doing business as

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Hospital certification: CCN 440001

Legal name

UNICOI COUNTY HOSPITAL

Certification status

Terminated Voluntary: merger or closure, Feb 1, 2025

Provider type (POS)

Hospital – Short-term

Participating since

Jul 1, 1966

Last certification

Oct 16, 2000

Beds

10

Ownership / control type

Private (not for profit)

Most recent change of ownership

Nov 1, 2013 (3 total)

Facility address

2030 Temple Hill Road
Erwin, TN 37650

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1383609600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1713225600000",
    "number": "1013346550",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "311 PRINCETON RD STE 1",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "376012026",
            "telephone_number": "423-743-3141",
            "fax_number": "423-743-1244"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2030 TEMPLE HILL RD",
            "city": "ERWIN",
            "state": "TN",
            "postal_code": "376508721",
            "telephone_number": "423-743-3141",
            "fax_number": "423-743-1244"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOUNTAIN STATES HEALTH ALLIANCE",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-11-05",
        "last_updated": "2024-04-16",
        "certification_date": "2024-04-16",
        "status": "A",
        "authorized_official_last_name": "HILTON",
        "authorized_official_first_name": "SHANE",
        "authorized_official_middle_name": "EDWIN",
        "authorized_official_title_or_position": "EVP/CFO",
        "authorized_official_telephone_number": "423-302-3467"
    },
    "taxonomies": [
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://67.32.31.88:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRResponse_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.1340.1",
            "affiliationName": "Mountain States Health Alliance",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "1.5, 1.6",
            "address_1": "2030 Temple Hill Rd",
            "city": "Erwin",
            "state": "TN",
            "country_code": "US",
            "postal_code": "376508721",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Unicoi County Hospital",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Medicone Medical Response of Tennessee Inc
• Frank Anthony Merendino III, DDS
• Adriene Nicole Miller, PHARMD
• Charles G Miller II, DO
• Gordon Wyche Moughon, MD
• Mountain States Health Alliance
• Mountain States Health Alliance
• Mountain States Health Alliance
• MPC
• Jessica Elam Murray, BSW

• General Acute Care Hospital in Erwin, TN
• Providers in Erwin, TN by specialty
• General Acute Care Hospital in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 16, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.