NPIMap

Organization Active NPI

Mountain States Health Alliance

Doing business as Medical Center Infusion Therapy

  • Home Infusion Agency
  • Johnson City, TN
National Provider Identifier
1053496901
Registry record updated Mar 29, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Infusion AgencyTaxonomy code 251F00000X
License
0000000434 Issued in TN
Legal business name
MOUNTAIN STATES HEALTH ALLIANCE
Doing business as
Medical Center Infusion Therapy
Practice address
101 Med Tech Pkwy
Suite 100
Johnson City, TN 37604-4007
Phone
(423) 431-4601
Fax
(423) 431-5733
NPI assigned
Oct 26, 2006
Last updated
Mar 29, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 29, 2018

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Home Infusion Agency 251F00000X 0000000434 TN Primary
Durable Medical Equipment & Medical Supplies 332B00000X

Addresses

Primary practice location

101 Med Tech Pkwy
Suite 100
Johnson City, TN 37604-4007

Mailing address

311 Princeton Rd Ste 1
Johnson City, TN 37601-2026
Phone (423) 431-4601

Other names 1

  • Medical Center Infusion Therapy Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Mountain States Health Alliance41 organizations share this tax ID, including this one

Other organizations with this tax ID 40

Organizations that report the same tax identification number in the National Provider Directory.

View all 40

Locations

101 Med Tech Pkwy
Ste 100
Johnson City, TN 37604
Phone (423) 431-7626

NPI Registry JSON

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

{
    "created_epoch": "1161820800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1522281600000",
    "number": "1053496901",
    "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": "423-431-4601",
            "fax_number": "423-431-5733"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 MED TECH PKWY",
            "address_2": "SUITE 100",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "376044007",
            "telephone_number": "423-431-4601",
            "fax_number": "423-431-5733"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOUNTAIN STATES HEALTH ALLIANCE",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-26",
        "last_updated": "2018-03-29",
        "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": "251F00000X",
            "taxonomy_group": "",
            "desc": "Home Infusion",
            "state": "TN",
            "license": "0000000434",
            "primary": true
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Medical Center Infusion Therapy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Johnson City, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 29, 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.