NPIMap

Organization Active NPI

Mountain States Medical Group

  • Pharmacotherapy Pharmacist
  • Elizabethton, TN
National Provider Identifier
1952770067
Registry record updated Sep 18, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pharmacotherapy PharmacistTaxonomy code 1835P1200X
License
38635 Issued in TN
Legal business name
MOUNTAIN STATES MEDICAL GROUP
Practice address
1497 W Elk Ave Ste 21
Elizabethton, TN 37643-2896
Phone
(423) 542-7420
NPI assigned
Sep 18, 2015
Last updated
Sep 18, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 18, 2015

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

Authorized official

Name
Brooklyn Nelson, PHARMD
Title
Pharmacist
Phone
(423) 542-7479

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacotherapy Pharmacist 1835P1200X 38635 TN Primary

Addresses

Primary practice location

1497 W Elk Ave Ste 21
Elizabethton, TN 37643-2896

Mailing address

1497 W Elk Ave Ste 21
Elizabethton, TN 37643-2896

Other identifiers 1

IdentifierTypeStateIssuer
1982036927OtherNCNPI

National Provider Directory

National Provider Directory
Tax ID family
MSMG Gen Surg Eliz a70 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 15

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1442534400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1442534400000",
    "number": "1952770067",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1497 W ELK AVE STE 21",
            "city": "ELIZABETHTON",
            "state": "TN",
            "postal_code": "376432896"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1497 W ELK AVE STE 21",
            "city": "ELIZABETHTON",
            "state": "TN",
            "postal_code": "376432896",
            "telephone_number": "423-542-7420"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOUNTAIN STATES MEDICAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-09-18",
        "last_updated": "2015-09-18",
        "status": "A",
        "authorized_official_last_name": "NELSON",
        "authorized_official_first_name": "BROOKLYN",
        "authorized_official_title_or_position": "PHARMACIST",
        "authorized_official_telephone_number": "423-542-7479",
        "authorized_official_credential": "PHARMD"
    },
    "taxonomies": [
        {
            "code": "1835P1200X",
            "taxonomy_group": "",
            "desc": "Pharmacist, Pharmacotherapy",
            "state": "TN",
            "license": "38635",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1982036927",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Elizabethton, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 2015; 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.