Provider Demographics
NPI:1861427783
Name:MOUNTAIN REGION SPEECH AND HEARING CENTER
Entity type:Organization
Organization Name:MOUNTAIN REGION SPEECH AND HEARING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF ADMINISTRATION
Authorized Official - Prefix:MRS
Authorized Official - First Name:MAVIS
Authorized Official - Middle Name:L
Authorized Official - Last Name:SPIVEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-246-4600
Mailing Address - Street 1:301 LOUIS STREET
Mailing Address - Street 2:SUITE 101
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37660-5195
Mailing Address - Country:US
Mailing Address - Phone:423-246-4600
Mailing Address - Fax:423-246-3311
Practice Address - Street 1:301 LOUIS STREET
Practice Address - Street 2:SUITE 101
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660-5195
Practice Address - Country:US
Practice Address - Phone:423-246-4600
Practice Address - Fax:423-246-3311
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-11
Last Update Date:2011-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA004978048Medicaid
VA004978048Medicaid