1457719130 NPI number — MISSION HEALTH COMMUNITY MULTISPECIALTY PROVIDERS, LLC

Table of Contents

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

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

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