Provider Demographics
NPI:1861463697
Name:MOUNTAIN MEDICAL ASSOCIATES LLP
Entity Type:Organization
Organization Name:MOUNTAIN MEDICAL ASSOCIATES LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:ZALABAK
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:828-452-0331
Mailing Address - Street 1:600 HOSPITAL DR
Mailing Address - Street 2:STE 9
Mailing Address - City:CLYDE
Mailing Address - State:NC
Mailing Address - Zip Code:28721
Mailing Address - Country:US
Mailing Address - Phone:828-452-0331
Mailing Address - Fax:828-456-8726
Practice Address - Street 1:600 HOSPITAL DR
Practice Address - Street 2:STE 9
Practice Address - City:CLYDE
Practice Address - State:NC
Practice Address - Zip Code:28721
Practice Address - Country:US
Practice Address - Phone:828-452-0331
Practice Address - Fax:828-456-8726
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-30
Last Update Date:2007-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8902173Medicaid
NC02173OtherBLUE CROSS/BLUE SHIELD
NC8902173Medicaid