Provider Demographics
NPI:1649416058
Name:MOSAIC COMPREHENSIVE CARE, PLLC
Entity Type:Organization
Organization Name:MOSAIC COMPREHENSIVE CARE, PLLC
Other - Org Name:CHAPEL HILL WOMEN'S MEDICINE, PLLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER (SOLE OWNER)
Authorized Official - Prefix:DR
Authorized Official - First Name:LOUISE
Authorized Official - Middle Name:DYSART
Authorized Official - Last Name:METZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:919-240-7269
Mailing Address - Street 1:1240 ENVIRON WAY
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27517
Mailing Address - Country:US
Mailing Address - Phone:919-240-7269
Mailing Address - Fax:919-240-7816
Practice Address - Street 1:1240 ENVIRON WAY
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27517
Practice Address - Country:US
Practice Address - Phone:919-240-7269
Practice Address - Fax:919-240-7816
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-07
Last Update Date:2017-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2008-01086207R00000X
NC30300207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC205068FMedicare PIN
NCC82998Medicare UPIN