| Mountain States Health Alliance | |
|
1501 W Elk Ave Elizabethton TN 37643-2874 | |
| (423) 542-1300 | |
| (423) 543-5372 |
| Full Name | Mountain States Health Alliance |
|---|---|
| Speciality | Psychiatric Unit |
| Location | 1501 W Elk Ave, Elizabethton, Tennessee |
| Authorized Official Name and Position | Shane Edwin Hilton (EVP/CFO) |
| Authorized Official Contact | 4233023467 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mountain States Health Alliance 311 Princeton Rd Ste 1 Johnson City TN 37601-2026 Ph: (423) 542-1300 | Mountain States Health Alliance 1501 W Elk Ave Elizabethton TN 37643-2874 Ph: (423) 542-1300 |
| NPI Number | 1710099742 |
|---|---|
| Provider Enumeration Date | 08/31/2006 |
| Last Update Date | 04/16/2024 |
| Certification Date | 04/16/2024 |
| Medicare PECOS PAC ID | 6002726718 |
|---|---|
| Medicare Enrollment ID | O20080806000262 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1710099742 | NPI | - | NPPES |
| 29725700 | Other | MAGELLAN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 273R00000X | Psychiatric Unit | 0000000012 (Tennessee) | Primary |
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