Provider Demographics
NPI:1477516698
Name:MOUNTAIN KIDNEY & HYPERTENSION ASSOCIATES, P.A.
Entity Type:Organization
Organization Name:MOUNTAIN KIDNEY & HYPERTENSION ASSOCIATES, P.A.
Other - Org Name:MOUNTAIN KIDNEY ASSOCIATES, P.A.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:CHRISTOPHER
Authorized Official - Last Name:CROOK
Authorized Official - Suffix:
Authorized Official - Credentials:MT
Authorized Official - Phone:828-258-5510
Mailing Address - Street 1:10 MCDOWELL ST
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28801-4104
Mailing Address - Country:US
Mailing Address - Phone:828-258-8545
Mailing Address - Fax:828-254-0714
Practice Address - Street 1:10 MCDOWELL ST
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28801-4104
Practice Address - Country:US
Practice Address - Phone:828-258-8545
Practice Address - Fax:844-378-7512
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-10
Last Update Date:2021-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC40057207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC02230OtherNC BLUE CROSS PROVIDER #
NC7902230Medicaid
NC230354Medicare ID - Type UnspecifiedMEDICARE GROUP PROVIDER #
NCC14125Medicare PIN