Provider Demographics
NPI:1205026630
Name:MOUNTAINTOP HEALTHCARE
Entity Type:Organization
Organization Name:MOUNTAINTOP HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DONDA
Authorized Official - Middle Name:C
Authorized Official - Last Name:BENNETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-454-5287
Mailing Address - Street 1:34 SIMS CIR
Mailing Address - Street 2:
Mailing Address - City:WAYNESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28786-3056
Mailing Address - Country:US
Mailing Address - Phone:828-454-5287
Mailing Address - Fax:828-454-5996
Practice Address - Street 1:34 SIMS CIR
Practice Address - Street 2:
Practice Address - City:WAYNESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28786-3056
Practice Address - Country:US
Practice Address - Phone:828-454-5287
Practice Address - Fax:828-454-5996
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-01
Last Update Date:2008-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5908203Medicaid
NC5908203Medicaid
NC2578503Medicare PIN