Provider Demographics
NPI:1043338908
Name:PRIMEHEALTH ASHEVILLE PA
Entity Type:Organization
Organization Name:PRIMEHEALTH ASHEVILLE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LENA
Authorized Official - Middle Name:F
Authorized Official - Last Name:LAUGHTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-274-9920
Mailing Address - Street 1:1 VANDERBILT PARK DR STE 200
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28803-1736
Mailing Address - Country:US
Mailing Address - Phone:828-274-9920
Mailing Address - Fax:
Practice Address - Street 1:1 VANDERBILT PARK DR STE 200
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28803
Practice Address - Country:US
Practice Address - Phone:828-274-9920
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2018-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200200029207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1679677819OtherMICHEAL P. SHEA NPI
NC89016E8Medicaid
NC1124088620OtherJOHN P GARDNER NPI
NC1114082948OtherELIZABETH F. GARDNER NPI
NC1124088620OtherJOHN P GARDNER NPI
NC1679677819OtherMICHEAL P. SHEA NPI
NCH72115Medicare UPIN
NC2339250Medicare ID - Type Unspecified