Provider Demographics
NPI:1760443097
Name:MOUNTAIN PODIATRY PA
Entity Type:Organization
Organization Name:MOUNTAIN PODIATRY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:HYMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:828-697-8686
Mailing Address - Street 1:2315 ASHEVILLE HWY
Mailing Address - Street 2:UNIT 10
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28791-1500
Mailing Address - Country:US
Mailing Address - Phone:828-697-8686
Mailing Address - Fax:828-697-0960
Practice Address - Street 1:2315 ASHEVILLE HWY
Practice Address - Street 2:UNIT 10
Practice Address - City:HENDERSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28791-1500
Practice Address - Country:US
Practice Address - Phone:828-697-8686
Practice Address - Fax:828-697-0960
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-28
Last Update Date:2008-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC446213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5905211Medicaid
NC0805JOtherBLUE CROSS BLUE SHIELD
NC5324590001Medicare NSC