Provider Demographics
NPI:1275576035
Name:MOUNTAIN SPINE AND REHABILITATION SPECIALISTS PLLC
Entity Type:Organization
Organization Name:MOUNTAIN SPINE AND REHABILITATION SPECIALISTS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:F
Authorized Official - Last Name:FLEMING
Authorized Official - Suffix:
Authorized Official - Credentials:CEO
Authorized Official - Phone:828-255-7776
Mailing Address - Street 1:7 VANDERBILT PARK DR
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28803-1700
Mailing Address - Country:US
Mailing Address - Phone:828-255-7776
Mailing Address - Fax:828-274-7855
Practice Address - Street 1:7 VANDERBILT PARK DR
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28803-1700
Practice Address - Country:US
Practice Address - Phone:828-255-7776
Practice Address - Fax:828-274-7855
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MOUNTAIN NEUROSURGICAL & SPINE CENTER PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-13
Last Update Date:2009-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1348442081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC018CMOtherBCBS NC PROVIDER #
NC2322706OtherMEDICARE PTAN
NC5903568Medicaid