Provider Demographics
NPI:1043220338
Name:MOUNTAIN EMPIRE MEDICAL AND SURGICAL ASSOCIATES PLLC
Entity Type:Organization
Organization Name:MOUNTAIN EMPIRE MEDICAL AND SURGICAL ASSOCIATES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:S
Authorized Official - Last Name:HECHT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:423-542-0400
Mailing Address - Street 1:1503 W ELK AVE
Mailing Address - Street 2:SUITE 8
Mailing Address - City:ELIZABETHTON
Mailing Address - State:TN
Mailing Address - Zip Code:37643-2876
Mailing Address - Country:US
Mailing Address - Phone:423-542-0400
Mailing Address - Fax:423-542-0201
Practice Address - Street 1:1503 W ELK AVE
Practice Address - Street 2:SUITE 8
Practice Address - City:ELIZABETHTON
Practice Address - State:TN
Practice Address - Zip Code:37643-2876
Practice Address - Country:US
Practice Address - Phone:423-542-0400
Practice Address - Fax:423-542-0201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-09
Last Update Date:2008-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3707825Medicaid
TN3707825Medicaid