Provider Demographics
NPI:1679966162
Name:MOUNTAIN HEALTH CLINIC, LLC
Entity Type:Organization
Organization Name:MOUNTAIN HEALTH CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FAMILY NURSE PRACTITIONER/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:M
Authorized Official - Last Name:SETSER
Authorized Official - Suffix:
Authorized Official - Credentials:APRN, FNP
Authorized Official - Phone:423-231-3801
Mailing Address - Street 1:260 HIGHWAY 107 S
Mailing Address - Street 2:
Mailing Address - City:DEL RIO
Mailing Address - State:TN
Mailing Address - Zip Code:37727-2654
Mailing Address - Country:US
Mailing Address - Phone:423-231-3801
Mailing Address - Fax:423-815-1250
Practice Address - Street 1:260 HIGHWAY 107 S
Practice Address - Street 2:
Practice Address - City:DEL RIO
Practice Address - State:TN
Practice Address - Zip Code:37727-2654
Practice Address - Country:US
Practice Address - Phone:423-623-3100
Practice Address - Fax:423-815-1250
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-09
Last Update Date:2021-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QP2300X
TN7003363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN39291721Medicaid
TN1891782702OtherPROVIDER NPI
TNP67796Medicare UPIN