East Tennessee Healthcare Holdings Inc

Primary specialty

Substance Use Disorder Rehabilitation Clinic/CenterTaxonomy code 261QR0405X

Legal business name

EAST TENNESSEE HEALTHCARE HOLDINGS INC

Practice address

203 Gray Commons Cir Ste 110
Gray, TN 37615-5407

Phone

(423) 467-2800

Fax

(423) 467-9656

NPI assigned

Dec 4, 2017

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 2

Addresses

Other names 1

• Overmountain Recovery Doing business as

Medicare fee-for-service enrollment

Enrolled in TN

Opioid treatment program

Medicare-enrolled since Jan 1, 2020

Enrollment records 1

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

Locations

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Ashley Bynum, MA, LPC-MHSP

  • Professional Counselor
  • Johnson City, TN
  • NPI 1861270571
  NPD
• Victoria White Johnson, PA-C

  • Physician Assistant
  • Johnson City, TN
  • NPI 1770079675
  NPD
• Gregory F Vines, MD

  • Family Medicine Physician
  • Greeneville, TN
  • NPI 1609819291
  NPD
• Frank Ryan Stump, MD

  • Psychiatry Physician
  • Toledo, OH
  • NPI 1346565686
  NPD
• Brian Edwin Condit, MD

  • Physical Medicine & Rehabilitation Physician
  • Tupelo, MS
  • NPI 1174570881
  NPD (past)

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

{
    "created_epoch": "1512345600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1713312000000",
    "number": "1033624853",
    "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": "423-467-2800",
            "fax_number": "423-467-9656"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "203 GRAY COMMONS CIR STE 110",
            "city": "GRAY",
            "state": "TN",
            "postal_code": "376155407",
            "telephone_number": "423-467-2800",
            "fax_number": "423-467-9656"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAST TENNESSEE HEALTHCARE HOLDINGS INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-12-04",
        "last_updated": "2024-04-17",
        "certification_date": "2024-04-17",
        "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": "261QM2800X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Methadone",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Overmountain Recovery",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Kathryn Contel, PT, DPT
• William Joseph Cote, FNP
• Melanie Dawn Davis
• Mandy Dishner, PHARM.D.
• John Elwood Douglas, M.D.
• East Tennessee State University
• East Tennessee State University
• Farmers Delight LLC
• Jaime Lea Ferguson, BCBA
• Kara Ferry, MSW

• Substance Use Disorder Rehabilitation Clinic/Center in Gray, TN
• Providers in Gray, TN by specialty
• Substance Use Disorder Rehabilitation Clinic/Center in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 17, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.