Mountain States Health Alliance

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

MOUNTAIN STATES HEALTH ALLIANCE

Doing business as

Unicoi County Nursing Home

Practice address

100 Greenway Cir
Erwin, TN 37650-2177

Phone

(423) 743-3141

Fax

(423) 743-1244

NPI assigned

Nov 5, 2013

Last updated

Mar 28, 2018By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mrs. Mary Lynn Krutak

Title

Evp/Cfo

Phone

(423) 302-3423

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• Unicoi County Nursing Home Doing business as

Member of 1

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

• Mountain States Health Alliance

  dba Sycamore Shoals Hospital Psychiatric Unit

  • Psychiatric Hospital Unit
  • Elizabethton, TN
  • NPI 1710099742

  Member Of

  NPD member

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

{
    "created_epoch": "1383609600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1522195200000",
    "number": "1922437466",
    "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": "423-743-3141",
            "fax_number": "423-743-1244"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 GREENWAY CIR",
            "city": "ERWIN",
            "state": "TN",
            "postal_code": "376502177",
            "telephone_number": "423-743-3141",
            "fax_number": "423-743-1244"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOUNTAIN STATES HEALTH ALLIANCE",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-11-05",
        "last_updated": "2018-03-28",
        "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",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "313M00000X",
            "taxonomy_group": "",
            "desc": "Nursing Facility/Intermediate Care Facility",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAID ICF",
            "identifier": "7440197",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAID SNF",
            "identifier": "0445077",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Unicoi County Nursing Home",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Charles G Miller II, DO
• Gordon Wyche Moughon, MD
• Mountain States Health Alliance (Unicoi County Hospital)
• Mountain States Health Alliance (Center for Sleep Disorders at UCMH)
• Mountain States Health Alliance (Unicoi County Home Health)
• MPC
• Jessica Elam Murray, BSW
• Kaylee Breanne Nicholson
• Nolachucky Medical
• Sara Jean O'Daniel, DMD

• Skilled Nursing Facility in Erwin, TN
• Providers in Erwin, TN by specialty
• Skilled Nursing Facility in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 28, 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.