1699891929 NPI number — MOUNTAIN AREA SPECTRUM CENTER

Table of content: (NPI 1699891929)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699891929 NPI number — MOUNTAIN AREA SPECTRUM CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MOUNTAIN AREA SPECTRUM CENTER
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:
PEDIATRIC THERAPY SOLUTIONS
Provider Other Organization Name Type Code:
3
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:
1699891929
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/15/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
20 MALLORY MEADOWS CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ARDEN
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28704-8552
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
828-687-1700
Provider Business Mailing Address Fax Number:
828-687-1175

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15 LOOP RD STE 9
Provider Second Line Business Practice Location Address:
SUITE 2B-3B
Provider Business Practice Location Address City Name:
ARDEN
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28704-8435
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
828-687-1700
Provider Business Practice Location Address Fax Number:
828-687-1175
Provider Enumeration Date:
03/21/2007

Additional Information

Authorized Official

Authorized Official Last Name:
DAVIS
Authorized Official First Name:
CHRISTY
Authorized Official Middle Name:
DENISE
Authorized Official Title or Position:
VICE PRESIDENT
Authorized Official Telephone Number:
828-687-1700

Provider Taxonomy Codes

  • Taxonomy code: 225X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 225XP0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 235Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 016U3 . This is a "BCBS" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 7211642 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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