Provider Demographics
NPI:1770821589
Name:MOUNTAIN COMMUNITY HEALTH PARTNERSHIP INCORPORATED
Entity Type:Organization
Organization Name:MOUNTAIN COMMUNITY HEALTH PARTNERSHIP INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-675-4116
Mailing Address - Street 1:86 N MITCHELL AVE
Mailing Address - Street 2:
Mailing Address - City:BAKERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28705-6502
Mailing Address - Country:US
Mailing Address - Phone:828-688-2104
Mailing Address - Fax:828-688-1334
Practice Address - Street 1:11728 S 226 HWY
Practice Address - Street 2:
Practice Address - City:SPRUCE PINE
Practice Address - State:NC
Practice Address - Zip Code:28777-8954
Practice Address - Country:US
Practice Address - Phone:828-766-7778
Practice Address - Fax:828-688-1334
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MOUNTAIN COMMUNITY HEALTH PARTNERSHIP INCORPORATED
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-01-29
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207Q00000X
NC261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty