Provider Demographics
NPI:1366473225
Name:CAROLINA MOUNTAIN INTERNAL MEDICINE
Entity Type:Organization
Organization Name:CAROLINA MOUNTAIN INTERNAL MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:BYRD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:828-698-9193
Mailing Address - Street 1:902 FLEMING ST STE C
Mailing Address - Street 2:
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28791-3504
Mailing Address - Country:US
Mailing Address - Phone:828-698-9193
Mailing Address - Fax:828-698-9155
Practice Address - Street 1:902 FLEMING ST STE C
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28791-3504
Practice Address - Country:US
Practice Address - Phone:828-698-9193
Practice Address - Fax:828-698-9155
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-06
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC118602207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0189LOtherBCBS
NC0189LOtherBCBS
NC2289348CMedicare PIN