1457719130 NPI number — MISSION HEALTH COMMUNITY MULTISPECIALTY PROVIDERS, LLC

Table of content: (NPI 1457719130)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457719130 NPI number — MISSION HEALTH COMMUNITY MULTISPECIALTY PROVIDERS, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MISSION HEALTH COMMUNITY MULTISPECIALTY PROVIDERS, LLC
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:
Provider Other Organization Name Type Code:
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:
1457719130
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/02/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2000 HEALTH PARK DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BRENTWOOD
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37027-4525
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-372-3375
Provider Business Mailing Address Fax Number:
828-651-6561

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
509 BILTMORE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ASHEVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28801-4601
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
828-213-2250
Provider Business Practice Location Address Fax Number:
828-213-2395
Provider Enumeration Date:
02/09/2016

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
JOSEPH
Authorized Official First Name:
LOUIS
Authorized Official Middle Name:
Authorized Official Title or Position:
VP
Authorized Official Telephone Number:
615-373-7630

Provider Taxonomy Codes

  • Taxonomy code: 207L00000X , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207LP2900X , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207LP3000X , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 367500000X , 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)

  • Identifier: 1457719130 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".