NPIMap

Organization Active NPI

Mountain States Health Alliance

Doing business as Russell County Psychiatric Unit

  • Psychiatric Hospital Unit
  • Lebanon, VA
National Provider Identifier
1568649697
Registry record updated Mar 29, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric Hospital UnitTaxonomy code 273R00000X
License
H1892 Issued in VA
Legal business name
MOUNTAIN STATES HEALTH ALLIANCE
Doing business as
Russell County Psychiatric Unit
Practice address
58 Carroll St
Lebanon, VA 24266-4510
Phone
(276) 883-8000
Fax
(276) 883-8250
NPI assigned
Jan 31, 2008
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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric Hospital Unit 273R00000X H1892 VA Primary

Addresses

Primary practice location

58 Carroll St
Lebanon, VA 24266-4510

Mailing address

311 Princeton Rd Ste 1
Johnson City, TN 37601-2026
Phone (276) 883-8000

Other names 1

  • Russell County Psychiatric Unit Doing business as

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1201737600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1522281600000",
    "number": "1568649697",
    "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": "276-883-8000",
            "fax_number": "276-883-8250"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "58 CARROLL ST",
            "city": "LEBANON",
            "state": "VA",
            "postal_code": "242664510",
            "telephone_number": "276-883-8000",
            "fax_number": "276-883-8250"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOUNTAIN STATES HEALTH ALLIANCE",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-01-31",
        "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": "273R00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Unit",
            "state": "VA",
            "license": "H1892",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Russell County Psychiatric Unit",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lebanon, VA

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.