Mountain States Health Alliance

Primary specialty

General Acute Care HospitalTaxonomy code 282N00000X

Legal business name

MOUNTAIN STATES HEALTH ALLIANCE

Practice address

630 Oneega LN
Suite E
Erwin, TN 37650-2197

Phone

(423) 431-6816

Fax

(423) 743-1244

NPI assigned

Jul 14, 2015

Organization subpart

No

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

Authorized official

Name

Mary Lynn Krutak

Title

Evp/Cfo

Phone

(423) 302-3423

Specialties & licenses 1

Addresses

Other names 2

• Center for Sleep Disorders at UCMH Doing business as
• UCMH Sleep Lab Doing business as

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

• Mountain States Health Alliance

  • Home Health Agency
  • Abingdon, VA
  • NPI 1962998732

  Member Of

  NPD member

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

{
    "created_epoch": "1436832000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1522713600000",
    "number": "1013391507",
    "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": "423-431-6816",
            "fax_number": "423-743-1244"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "630 ONEEGA LN",
            "address_2": "SUITE E",
            "city": "ERWIN",
            "state": "TN",
            "postal_code": "376502197",
            "telephone_number": "423-431-6816",
            "fax_number": "423-743-1244"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOUNTAIN STATES HEALTH ALLIANCE",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-07-14",
        "last_updated": "2018-04-03",
        "status": "A",
        "authorized_official_last_name": "KRUTAK",
        "authorized_official_first_name": "MARY",
        "authorized_official_middle_name": "LYNN",
        "authorized_official_title_or_position": "EVP/CFO",
        "authorized_official_telephone_number": "423-302-3423"
    },
    "taxonomies": [
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Center for Sleep Disorders at UCMH",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "UCMH Sleep Lab",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• 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
• Kaylee Breanne Nicholson

• 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 3, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.