Mountain States Health Alliance
Organization Active NPI Rural Health Clinic/Center · St Paul, VA
NPI 1386813616 · NPPES record last updated Aug 12, 2024
Key facts
- NPI
- 1386813616
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Rural Health Clinic/Center 261QR1300X
- Legal business name
- MOUNTAIN STATES HEALTH ALLIANCE
- Practice address
- 16431 Wise St
St Paul, VA 24283 - Phone
- (276) 762-2300
- Fax
- (276) 762-0612
- NPI assigned
- Feb 20, 2008
- Organization subpart
- No
Authorized official
- Name
- Juanita Harwood
- Title
- Director
- Phone
- (423) 392-6565
Other NPIs on the same Medicare enrollment 1
Member of 1
Practitioners 6
-
Edgar Michael Kahn, M.D.
-
Thomas E Renfro, MD
-
Laura Marie Walts, M.A., LPC
-
Johanna Galyen, FNP-C
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in VA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20161216000941 | VA | Part B Supplier - Clinic/Group Practice | 6002726718 |
Receives reassigned benefits from 15 practitioners 1 other NPI on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Lebanon, VA; Saint Paul, VA |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | |||
| Rural Health Clinic/Center | 261QR1300X | Yes |
Addresses
Primary practice location
16431 Wise St
St Paul, VA 24283
Mailing address
1021 W Oakland Ave Ste 310
Johnson City, TN 37604-2192
Phone (423) 302-6567
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 020157701 | Other | VI | DEPARTMENT OF LABOR |
| 1386813616 | Medicaid | VA |
Other names
- BHRHC ST PAUL
- BHRHC St. Paul
- MSMG FP ST PA
Other providers in St Paul, VA
- Julie Large
- Derek Lester McCowan
- Anthony D Meade
- Sabrina Mitchell
- Mountain States Health Alliance
- Mountain States Health Alliance
- Oxbow Corporation
- Ryan Lowry Patrick
- Paulina Rios
- Andrew Jordan Rosenfeld
All providers in St Paul, VA · Rural Health Clinic/Center in Virginia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 12, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.