NPIMap

Organization Active NPI

Mountain States Health Alliance

Doing business as BH Specialty Pharmacy-KPT

  • Pharmacy
  • Kingsport, TN
National Provider Identifier
1548842602
Registry record updated Jan 24, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacyTaxonomy code 333600000X
Legal business name
MOUNTAIN STATES HEALTH ALLIANCE
Doing business as
BH Specialty Pharmacy-KPT
Practice address
2202 N John B Dennis Hwy
Kingsport, TN 37660-5904
Phone
(423) 434-7443
Fax
(423) 302-3537
NPI assigned
Apr 27, 2021
Last updated
Jan 24, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 24, 2022

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
Pharmacy 333600000X Primary
Specialty Pharmacy 3336S0011X

Addresses

Primary practice location

2202 N John B Dennis Hwy
Kingsport, TN 37660-5904

Mailing address

2 Professional Park Dr Ste 15
Johnson City, TN 37604-6584
Phone (423) 434-7443

Other identifiers 1

IdentifierTypeStateIssuer
0440176MedicaidTN

Other names 1

  • BH Specialty Pharmacy-KPT Doing business as

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
44D2018787Mountain States Health Alliance2202 N John B Dennis Hwy, Ste 100, Kingsport, TN 37660ComplianceApr 6, 2027

National Provider Directory

National Provider Directory
Tax ID family
Mountain States Psychia41 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

NPI Registry JSON

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

{
    "created_epoch": "1619481600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1642982400000",
    "number": "1548842602",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2 PROFESSIONAL PARK DR STE 15",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "376046584",
            "telephone_number": "423-434-7443",
            "fax_number": "423-302-3537"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2202 N JOHN B DENNIS HWY",
            "city": "KINGSPORT",
            "state": "TN",
            "postal_code": "376605904",
            "telephone_number": "423-434-7443",
            "fax_number": "423-302-3537"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOUNTAIN STATES HEALTH ALLIANCE",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-04-27",
        "last_updated": "2022-01-24",
        "certification_date": "2022-01-24",
        "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": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "3336S0011X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Specialty Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0440176",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "BH Specialty Pharmacy-KPT",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "BH Specialty Pharmacy-KPT",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Kingsport, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 24, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.