Provider Demographics
NPI:1023020682
Name:GREAT SMOKIES MEDICAL CENTER
Entity Type:Organization
Organization Name:GREAT SMOKIES MEDICAL CENTER
Other - Org Name:GREAT SMOKIES MEDICAL CENTER OF ASHEVILLE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:PAT
Authorized Official - Middle Name:
Authorized Official - Last Name:GALLIMORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-252-9833
Mailing Address - Street 1:1312 PATTON AVE
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28806-2604
Mailing Address - Country:US
Mailing Address - Phone:828-252-9833
Mailing Address - Fax:828-255-8118
Practice Address - Street 1:1312 PATTON AVE
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28806-2604
Practice Address - Country:US
Practice Address - Phone:828-252-9833
Practice Address - Fax:828-255-8118
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-12
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC38342174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC02998OtherBLUE CROSS OF NORTH CAROL
NC2312659Medicare ID - Type Unspecified