1649416058 NPI number — MOSAIC COMPREHENSIVE CARE, PLLC

Table of content: (NPI 1649416058)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649416058 NPI number — MOSAIC COMPREHENSIVE CARE, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MOSAIC COMPREHENSIVE CARE, PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
CHAPEL HILL WOMEN'S MEDICINE, PLLC
Provider Other Organization Name Type Code:
4
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1649416058
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/03/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1240 ENVIRON WAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHAPEL HILL
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27517
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-240-7269
Provider Business Mailing Address Fax Number:
919-240-7816

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1240 ENVIRON WAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHAPEL HILL
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27517
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-240-7269
Provider Business Practice Location Address Fax Number:
919-240-7816
Provider Enumeration Date:
01/07/2009

Additional Information

Authorized Official

Authorized Official Last Name:
METZ
Authorized Official First Name:
LOUISE
Authorized Official Middle Name:
DYSART
Authorized Official Title or Position:
OWNER (SOLE OWNER)
Authorized Official Telephone Number:
919-240-7269

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  2008-01086 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207VG0400X , with the licence number: 30300 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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