INDIAN PATH PAVILION
NPI 1417050980
Psychiatric Unit in Kingsport, TN

Active since September 07, 2006
2300 PAVILION DR, KINGSPORT, TN 37660(423) 857-5500(423) 857-7078 Get Directions Write a Review

NPPES record last updated: October 15, 2015. Verified against the NPPES registry weekly; last sync: July 26, 2026.

About Indian Path Pavilion NPPES

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

INDIAN PATH PAVILION (NPI 1417050980) is a healthcare organization registered as a psychiatric unit in Kingsport, Tennessee and active in the NPI registry since September 2006. The organization lists Mary L Krutak, Svp/cfo, as its authorized official.

NPPES Registry Identity

NPI1417050980
Entity TypeOrganization
Primary Taxonomy273R00000X
Legal Business NameMOUNTAIN STATES HEALTH ALLIANCE
Location Address2300 PAVILION DRKingsport, TN 37660-4622
Mailing Address311 Princeton RdJohnson City, TN 37601-2026 · (423) 431-1941 · Fax (423) 431-1244
Fax(423) 857-7078
Organization SubpartNo
Authorized OfficialMary L KrutakSvp/cfo · (423) 431-6111
Enumeration DateSeptember 7, 2006
Last NPPES UpdateOctober 15, 2015
NPI 1417050980 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

Primary SpecialtyPsychiatric UnitHospital Units
Taxonomy Code273R00000X
License Licensed in TN · 0000000134
Definition

In general, a distinct unit of a hospital that provides acute or long-term care to emotionally disturbed patients, including patients admitted for diagnosis and those admitted for treatment of psychiatric problems on the basis of physicians' orders and approved nursing care plans. Long-term care may include intensive supervision to the chronically mentally ill, mentally disordered or other mentally incompetent persons; (2) For Medicare, a distinct part of a general acute care hospital admitting only patients whose admission to the unit is required for active treatment, whose treatment is of an intensity that can be provided only in an inpatient hospital setting, and whose condition is described by a psychiatric principal diagnosis contained in the Third Edition of the American Psychiatric Association Diagnostic and Statistical Manual or in Chapter 5 (Mental Disorders) of the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM). The unit must furnish, through the use of qualified personnel, psychological services, social work services, psychiatric nursing, occupational therapy, and recreational therapy. The unit must maintain medical records that permit determination of the degree and intensity of treatment provided to individuals who are furnished services in the unit; the unit must meet special staff requirements in that the unit must have adequate numbers of qualified professional and supportive staff to evaluate inpatients, formulate written, individualized, comprehensive treatment plans, provide active treatment measures and engage in discharge planning.

2300 PAVILION DR, Kingsport, TN 37660

Other Names 1

Doing Business AsIndian Path Pavilion

Other Identifiers 11

Medicaid4699873MI
Medicaid4400176NC
Medicare OSCAR/certification44S0176TN
Medicaid00672239MS
Medicaid01600113KY
Medicaid091618800FL
Medicaid000127730SC
Medicaid0938025OH
Other17505000Megellan
Medicaid000363855XGA
Medicaid004401760VA

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.

Physical Therapy Assistant
2300 PAVILION DR
KINGSPORT, TN 37660
Occupational Therapy Assistant
2300 PAVILION DR
KINGSPORT, TN 37660
Occupational Therapy Assistant
2300 PAVILION DR
KINGSPORT, TN 37660
Physical Therapy Assistant
2300 PAVILION DR
KINGSPORT, TN 37660
Occupational Therapy Assistant
2300 PAVILION DR
KINGSPORT, TN 37660
Counselor (Professional)
2300 PAVILION DR
KINGSPORT, TN 37660
Occupational Therapy Assistant
2300 PAVILION DR
KINGSPORT, TN 37660
Physical Therapy Assistant
2300 PAVILION DR
KINGSPORT, TN 37660

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 1417050980. It was assigned to this organization in the NPPES registry on September 7, 2006. The provider is doing business as Indian Path Pavilion.

Where is Mountain States Health Alliance located?

Mountain States Health Alliance is located at 2300 Pavilion Dr, Kingsport, TN 37660. The listed phone number is (423) 857-5500.

What is Mountain States Health Alliance's specialty?

The primary specialty registered for this NPI is Psychiatric Unit with taxonomy code 273R00000X.

When was this NPI record last updated?

The NPPES record for Mountain States Health Alliance was last updated on October 15, 2015. NPI Profile syncs with the weekly NPPES data releases published by CMS.