Provider Demographics
NPI: | 1821568049 |
---|---|
Name: | MISSION COMMUNITY ANESTHESIOLOGY SPECIALISTS LLC |
Entity Type: | Organization |
Organization Name: | MISSION COMMUNITY ANESTHESIOLOGY SPECIALISTS LLC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | PROVIDER ENROLLMENT SPECIALIST |
Authorized Official - Prefix: | |
Authorized Official - First Name: | CAROL |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | HILL |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 828-651-6579 |
Mailing Address - Street 1: | PO BOX 603366 |
Mailing Address - Street 2: | |
Mailing Address - City: | CHARLOTTE |
Mailing Address - State: | NC |
Mailing Address - Zip Code: | 28260-3366 |
Mailing Address - Country: | US |
Mailing Address - Phone: | |
Mailing Address - Fax: | 828-651-6575 |
Practice Address - Street 1: | 509 BILTMORE AVE |
Practice Address - Street 2: | |
Practice Address - City: | ASHEVILLE |
Practice Address - State: | NC |
Practice Address - Zip Code: | 28801-4601 |
Practice Address - Country: | US |
Practice Address - Phone: | 828-213-1740 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | Yes |
Parent Organization LBN: | MISSION COMMUNITY ANESTHESIOLOGY SPECIALISTS LLC |
Parent Organization TIN: | <UNAVAIL> |
Enumeration Date: | 2018-11-30 |
Last Update Date: | 2018-11-30 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 207RH0002X | Allopathic & Osteopathic Physicians | Internal Medicine | Hospice and Palliative Medicine | Group - Multi-Specialty |
No | 207LH0002X | Allopathic & Osteopathic Physicians | Anesthesiology | Hospice and Palliative Medicine | Group - Multi-Specialty |
No | 207QH0002X | Allopathic & Osteopathic Physicians | Family Medicine | Hospice and Palliative Medicine | Group - Multi-Specialty |
No | 207VH0002X | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Hospice and Palliative Medicine | Group - Multi-Specialty |
No | 2080H0002X | Allopathic & Osteopathic Physicians | Pediatrics | Hospice and Palliative Medicine | Group - Multi-Specialty |
No | 2081H0002X | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Hospice and Palliative Medicine | Group - Multi-Specialty |
No | 2084H0002X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Hospice and Palliative Medicine | Group - Multi-Specialty |
No | 2086H0002X | Allopathic & Osteopathic Physicians | Surgery | Hospice and Palliative Medicine | Group - Multi-Specialty |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
NC | 02CG9 | Other | BCBS |