MOUNTAIN STATES HEALTH ALLIANCE
NPI 1124426259
Pediatrics in Johnson City, TN

Q: What is Mountain States Health Alliance's NPI number?

The NPI number for Mountain States Health Alliance is 1124426259. It was assigned to this organization in the NPPES registry on December 5, 2014.

Q: What is Mountain States Health Alliance's specialty?

The primary specialty registered for this NPI is Pediatrics with taxonomy code 208000000X.

Active since December 05, 2014

400 N STATE OF FRANKLIN RD, NISWONGER CHILDREN'S HOSPITAL ADMIN, JOHNSON CITY, TN 37604(423) 431-4847(423) 431-3949 Get Directions Write a Review

NPPES record last updated: February 26, 2018. Verified against the NPPES registry weekly; last sync: August 09, 2026.

On this page

About Mountain States Health Alliance NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MOUNTAIN STATES HEALTH ALLIANCE (NPI 1124426259) is a healthcare organization registered as a pediatrics in Johnson City, Tennessee and active in the NPI registry since December 2014. The organization lists Mary Lynn Krutak, Evp/cfo, as its authorized official.

NPPES Registry Identity

NPI1124426259

Entity TypeOrganization

Primary Taxonomy208000000X

Legal Business NameMOUNTAIN STATES HEALTH ALLIANCE

Location Address400 N STATE OF FRANKLIN RD, NISWONGER CHILDREN'S HOSPITAL ADMINJohnson City, TN 37604-6035

Mailing Address311 Princeton Rd Ste 1Johnson City, TN 37601-2026 · (423) 431-4847 · Fax (423) 431-3949

Phone(423) 431-4847

Fax(423) 431-3949

Organization SubpartNo

Authorized OfficialMary Lynn KrutakEvp/cfo · (423) 302-3423

Enumeration DateDecember 5, 2014

Last NPPES UpdateFebruary 26, 2018

✔ NPI 1124426259 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 3

★ Primary SpecialtyPediatricsAllopathic & Osteopathic Physicians

Taxonomy Code208000000X

Definition

A pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development.

Also ListedPediatrics · Pediatric Critical Care MedicineTaxonomy 2080P0203X

Also ListedNurse Practitioner · PediatricsTaxonomy 363LP0200X

400 N STATE OF FRANKLIN RD, Johnson City, TN 37604

Open in Google Maps ↗

Other Identifiers 1

MedicaidQ010765TN

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X MULTIPLE SINGLE SPECIALTY GROUP

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. CASEY JAMES WILBERT PHARM.D

Pharmacist

400 N STATE OF FRANKLIN RD
JOHNSON CITY, TN 37604

Washington County (423) 431-2787

BLUE RIDGE MEDICAL MANAGEMENT CORPORATION

Internal Medicine (Cardiovascular Disease)

400 N STATE OF FRANKLIN RD, ROOM LK015
JOHNSON CITY, TN 37604

Washington County (423) 431-5965

MITCHELL DESHAZER

Internal Medicine (Critical Care Medicine)

400 N STATE OF FRANKLIN RD, ROOM 2746
JOHNSON CITY, TN 37604

Washington County (423) 431-2727

DR. ANDREW LEE GIBSON MD

Emergency Medicine

400 N STATE OF FRANKLIN RD
JOHNSON CITY, TN 37604

Washington County (423) 431-6111

MCKENZIE PEARL GREGG PA-C, MMS, MPH

Physician Assistant

400 N STATE OF FRANKLIN RD
JOHNSON CITY, TN 37604

Washington County (423) 431-6111

OLUWATOSIN ORIOLA AYANJOKE MD

Family Medicine

400 N STATE OF FRANKLIN RD
JOHNSON CITY, TN 37604

Washington County (423) 431-6111

HUNTER DORTON

Student in an Organized Health Care Education/Training Program

400 N STATE OF FRANKLIN RD
JOHNSON CITY, TN 37604

Washington County (423) 431-6111

DR. LEON CHARLES BASS M.D.

Internal Medicine (Pulmonary Disease)

400 N STATE OF FRANKLIN RD, ROOM 2746
JOHNSON CITY, TN 37604

Washington County (423) 431-2727

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Mountain States Health Alliance's NPI number?

The NPI number for Mountain States Health Alliance is 1124426259. It was assigned to this organization in the NPPES registry on December 5, 2014.

Where is Mountain States Health Alliance located?

Mountain States Health Alliance is located at 400 N State Of Franklin Rd Niswonger Children's Hospital Admin, Johnson City, TN 37604. The listed phone number is (423) 431-4847.

What is Mountain States Health Alliance's specialty?

The primary specialty registered for this NPI is Pediatrics with taxonomy code 208000000X.

When was this NPI record last updated?

The NPPES record for Mountain States Health Alliance was last updated on February 26, 2018. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 8 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.