Mountain States Health Alliance

Primary specialty

Community Based Hospice Care AgencyTaxonomy code 251G00000X

Legal business name

MOUNTAIN STATES HEALTH ALLIANCE

Practice address

312 Hospital Dr Suite 1B
Clintwood, VA 24228

Phone

(276) 926-6600

Fax

(276) 926-6783

NPI assigned

Jun 15, 2017

Organization subpart

No

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

Addresses

Other names 1

• Ballad Health Hospice Doing business as

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

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

{
    "created_epoch": "1497484800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1550534400000",
    "number": "1669902243",
    "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": "276-926-6600",
            "fax_number": "276-926-6783"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "312 HOSPITAL DR SUITE 1B",
            "city": "CLINTWOOD",
            "state": "VA",
            "postal_code": "24228",
            "telephone_number": "276-926-6600",
            "fax_number": "276-926-6783"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOUNTAIN STATES HEALTH ALLIANCE",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-06-15",
        "last_updated": "2019-02-19",
        "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": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": "VA",
            "license": null,
            "primary": false
        },
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Ballad Health Hospice",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Timothy Patrick McCarty, PHARMD
• Amy Meade, PHARMD
• Samir Samuel Missak, MD
• Momentum Recovery Virginia LLC
• Mountain States Health Alliance
• Anthony Mullins, MA
• April Renee Mullins, BS
• Bethany Mullins, CCC-SLP
• Chloe Mullins
• Elizabeth M Newberry, PT

• Community Based Hospice Care Agency in Clintwood, VA
• Providers in Clintwood, VA by specialty
• Community Based Hospice Care Agency in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 19, 2019; 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.