NPIMap

Organization Active NPI

Mountain States Health Alliance

Doing business as Johnson City Specialty Hospital

  • General Acute Care Hospital
  • Johnson City, TN
National Provider Identifier
1023129376
Registry record updated Aug 12, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Acute Care HospitalTaxonomy code 282N00000X
License
0000000122 Issued in TN
Legal business name
MOUNTAIN STATES HEALTH ALLIANCE
Doing business as
Johnson City Specialty Hospital
Practice address
203 E Watauga Ave
Johnson City, TN 37601-4629
Phone
(423) 926-1111
Fax
(423) 979-6163
NPI assigned
Aug 31, 2006
Last updated
Aug 12, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 12, 2008

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

Authorized official

Name
Marvin H Eichorn
Title
SVP/Cfo
Phone
(423) 431-6111

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Acute Care Hospital 282N00000X 0000000122 TN Primary

Addresses

Primary practice location

203 E Watauga Ave
Johnson City, TN 37601-4629

Mailing address

203 E Watauga Ave
Johnson City, TN 37601-4629
Phone (423) 926-1111

Other names 1

  • Johnson City Specialty Hospital Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1023129376. Details of each certification follow.

Hospital certification: CCN 440105

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
JOHNSON CITY SPECIALTY HOSPITAL
Certification status
Terminated Voluntary: merger or closure, Jun 17, 2010
Provider type (POS)
Hospital – Short-term
Participating since
Oct 1, 1979
Last certification
May 29, 2009
Beds
49
Ownership / control type
Private (not for profit)
Facility address
203 E Watauga Ave
Johnson City, TN 37601

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1156982400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1218499200000",
    "number": "1023129376",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "203 E WATAUGA AVE",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "376014629",
            "telephone_number": "423-926-1111",
            "fax_number": "423-979-6163"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "203 E WATAUGA AVE",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "376014629",
            "telephone_number": "423-926-1111",
            "fax_number": "423-979-6163"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOUNTAIN STATES HEALTH ALLIANCE",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-31",
        "last_updated": "2008-08-12",
        "status": "A",
        "authorized_official_last_name": "EICHORN",
        "authorized_official_first_name": "MARVIN",
        "authorized_official_middle_name": "H",
        "authorized_official_title_or_position": "SVP/CFO",
        "authorized_official_telephone_number": "423-431-6111"
    },
    "taxonomies": [
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": "TN",
            "license": "0000000122",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Johnson City Specialty Hospital",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Johnson City, TN

Sources for this page

Verify at the official NPI Registry.