Mountain States Health Alliance
NPI #1124426259 in Johnson City, Tennessee
Provider Information
- NPI Number
- 1124426259
- Entity Type
- Organization
- Organization Name
- Mountain States Health Alliance
- Primary Specialty
- Pediatrics
- Enumeration Date
- Dec 5, 2014
- Last Updated
- Feb 26, 2018
Practice Location
- Address
- 400 N STATE OF FRANKLIN RD
- Address 2
- NISWONGER CHILDREN'S HOSPITAL ADMIN
- City
- Johnson City
- State
- Tennessee
- ZIP Code
- 37604-6035
- Phone
- (423) 431-4847
Authorized Official
- Name
- MARY LYNN KRUTAK
- Title
- EVP/CFO
- Phone
- (423) 302-3423
Specialties & Taxonomy Codes
| Specialty |
|---|
| Pediatrics - Pediatric Critical Care Medicine — Pediatric Critical Care Medicine |
| Nurse Practitioner - Pediatrics — Pediatrics |
| Pediatrics |
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