Provider Demographics
NPI:1306036041
Name:MOUNTAIN STATES HEALTH ALLIANCE
Entity Type:Organization
Organization Name:MOUNTAIN STATES HEALTH ALLIANCE
Other - Org Name:MOUNTAIN STATES LIFELINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SVP/CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:MARVIN
Authorized Official - Middle Name:H
Authorized Official - Last Name:EICHORN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-431-6111
Mailing Address - Street 1:1021 W OAKLAND AVE
Mailing Address - Street 2:SUITE 310
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37604-2191
Mailing Address - Country:US
Mailing Address - Phone:423-952-3732
Mailing Address - Fax:423-952-3750
Practice Address - Street 1:1021 W OAKLAND AVE
Practice Address - Street 2:SUITE 310
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604-2191
Practice Address - Country:US
Practice Address - Phone:423-952-3732
Practice Address - Fax:423-952-3750
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-30
Last Update Date:2007-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes146D00000XEmergency Medical Service ProvidersPersonal Emergency Response AttendantGroup - Single Specialty