Provider Demographics
NPI:1326049347
Name:MOUNTAIN PEOPLES HEALTH COUNCILS INC.
Entity Type:Organization
Organization Name:MOUNTAIN PEOPLES HEALTH COUNCILS INC.
Other - Org Name:HUNTSVILLE PRIMARY CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:C
Authorized Official - Last Name:LOVETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-286-4141
Mailing Address - Street 1:470 INDUSTRIAL LN
Mailing Address - Street 2:
Mailing Address - City:ONEIDA
Mailing Address - State:TN
Mailing Address - Zip Code:37841-6294
Mailing Address - Country:US
Mailing Address - Phone:423-286-4141
Mailing Address - Fax:423-286-4145
Practice Address - Street 1:2974 BAKER HWY
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37756-3806
Practice Address - Country:US
Practice Address - Phone:423-663-9200
Practice Address - Fax:423-663-3389
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-02
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X, 1041C0700X, 174400000X, 208000000X, 363LP0200X, 364SP0200X
TN261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)Group - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatricsGroup - Multi-Specialty
No364SP0200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN441824Medicare Oscar/Certification
TN3704396Medicare PIN