Provider Demographics
NPI:1568689826
Name:CAROLINA MOUNTAIN MEDICAL
Entity Type:Organization
Organization Name:CAROLINA MOUNTAIN MEDICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:A
Authorized Official - Last Name:ENGEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:828-488-4205
Mailing Address - Street 1:45 PLATEAU ST
Mailing Address - Street 2:SUITE 250
Mailing Address - City:BRYSON CITY
Mailing Address - State:NC
Mailing Address - Zip Code:28713-6784
Mailing Address - Country:US
Mailing Address - Phone:828-488-4205
Mailing Address - Fax:828-488-4240
Practice Address - Street 1:45 PLATEAU ST
Practice Address - Street 2:SUITE 250
Practice Address - City:BRYSON CITY
Practice Address - State:NC
Practice Address - Zip Code:28713-6784
Practice Address - Country:US
Practice Address - Phone:828-488-4205
Practice Address - Fax:828-488-4240
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC011XMOtherBCBS
NC2344702Medicare PIN