| Organization Name: | MOUNTAIN STATES HEALTH ALLIANCE |
| NPI Number: | 1518079532 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | MARY LYNN KRUTAK (SVP/CFO) |
| Mailing Address: | 1987 S Shady St Mountain City |
| State: | TN US |
| Postal Code: | 376832021 |
| Phone Number: | 4237271100 |
| Fax Number: | 4237271112 |
| NPI Enumeration Date: | 08/31/2006 |
| NPI Last Update Date: | 10/30/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QR1300X |
| License Number: | 0000000038 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | TN |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Rural Health |
| Taxonomy Definition: | |