1952522179 NPI number — MOUNTAIN DIABETES AND ENDOCRINE CENTER PLLC

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 1952522179 NPI number — MOUNTAIN DIABETES AND ENDOCRINE CENTER PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MOUNTAIN DIABETES AND ENDOCRINE CENTER 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:
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:
1952522179
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/05/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1998 HENDERSONVILLE RD
Provider Second Line Business Mailing Address:
SUITE 31
Provider Business Mailing Address City Name:
ASHEVILLE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28803-2349
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
828-684-9588
Provider Business Mailing Address Fax Number:
828-684-9626

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1998 HENDERSONVILLE RD
Provider Second Line Business Practice Location Address:
SUITE 31
Provider Business Practice Location Address City Name:
ASHEVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28803-2349
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
828-684-9588
Provider Business Practice Location Address Fax Number:
828-684-9626
Provider Enumeration Date:
05/02/2007

Additional Information

Authorized Official

Authorized Official Last Name:
WEINRIB
Authorized Official First Name:
STEPHEN
Authorized Official Middle Name:
LOUIS
Authorized Official Title or Position:
CO-OWNER
Authorized Official Telephone Number:
828-684-9588

Provider Taxonomy Codes

  • Taxonomy code: 207RE0101X , 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: 012E3 . This is a "BCBS GROUP NUMBER" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 89012E3 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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