NPIMap

Organization Active NPI

Mountain States Health Alliance

Doing business as Mountain States Rehabilitation at IPMC

  • General Acute Care Hospital
  • Kingsport, TN
National Provider Identifier
1720468200
Registry record updated Dec 11, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Acute Care HospitalTaxonomy code 282N00000X
License
134 Issued in TN
Legal business name
MOUNTAIN STATES HEALTH ALLIANCE
Doing business as
Mountain States Rehabilitation at IPMC
Practice address
2204 Pavilion Dr
Suite 115
Kingsport, TN 37660-4657
Phone
(423) 857-6777
Fax
(423) 857-6788
NPI assigned
Jun 1, 2015
Last updated
Dec 11, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 11, 2017

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Gregory Lee Wilgocki
Title
Corp Director Reimbursement
Phone
(423) 431-5794

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Acute Care Hospital 282N00000X 134 TN Primary

Addresses

Primary practice location

2204 Pavilion Dr
Suite 115
Kingsport, TN 37660-4657

Mailing address

311 Princeton Rd Ste 1
Johnson City, TN 37601-2026
Phone (423) 857-6777

Other names 1

  • Mountain States Rehabilitation at IPMC Doing business as

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

Locations

2204 Pavilion Dr
Ste 115
Kingsport, TN 37660
Phone (423) 239-5141

NPI Registry JSON

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

{
    "created_epoch": "1433116800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1512950400000",
    "number": "1720468200",
    "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": "423-857-6777",
            "fax_number": "423-857-6788"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2204 PAVILION DR",
            "address_2": "SUITE 115",
            "city": "KINGSPORT",
            "state": "TN",
            "postal_code": "376604657",
            "telephone_number": "423-857-6777",
            "fax_number": "423-857-6788"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOUNTAIN STATES HEALTH ALLIANCE",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-06-01",
        "last_updated": "2017-12-11",
        "status": "A",
        "authorized_official_last_name": "WILGOCKI",
        "authorized_official_first_name": "GREGORY",
        "authorized_official_middle_name": "LEE",
        "authorized_official_title_or_position": "CORP DIRECTOR REIMBURSEMENT",
        "authorized_official_telephone_number": "423-431-5794"
    },
    "taxonomies": [
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": "TN",
            "license": "134",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mountain States Rehabilitation at IPMC",
            "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 Dec 11, 2017; 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.