Provider Demographics
NPI:1619920550
Name:MOUNTAIN EAR NOSE & THROAT ASSOCIATES PA
Entity Type:Organization
Organization Name:MOUNTAIN EAR NOSE & THROAT ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINSITRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MISTIE
Authorized Official - Middle Name:G
Authorized Official - Last Name:COLLINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-586-7474
Mailing Address - Street 1:38 THE VILLAGE OVERLOOK
Mailing Address - Street 2:
Mailing Address - City:SYLVA
Mailing Address - State:NC
Mailing Address - Zip Code:28779-2742
Mailing Address - Country:US
Mailing Address - Phone:828-586-7474
Mailing Address - Fax:828-586-7473
Practice Address - Street 1:38 THE VILLAGE OVERLOOK
Practice Address - Street 2:
Practice Address - City:SYLVA
Practice Address - State:NC
Practice Address - Zip Code:28779-2616
Practice Address - Country:US
Practice Address - Phone:828-586-7474
Practice Address - Fax:828-586-7473
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-19
Last Update Date:2021-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890207RMedicaid
NC0207ROtherBLUE CROSS BLUE SHIELD NC
NC89016U1Medicaid
NCDA0153OtherRAILROAD MEDICARE
NC2319276Medicare PIN
NC2319276AMedicare PIN