Provider Demographics
NPI:1881659456
Name:MOUNTAIN REGIONAL EAR, NOSE & THROAT, PA
Entity Type:Organization
Organization Name:MOUNTAIN REGIONAL EAR, NOSE & THROAT, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:MALICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-654-9299
Mailing Address - Street 1:7 WALDEN RIDGE DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28803-8590
Mailing Address - Country:US
Mailing Address - Phone:828-654-9299
Mailing Address - Fax:828-654-9266
Practice Address - Street 1:7 WALDEN RIDGE
Practice Address - Street 2:SUITE 200
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28803-8590
Practice Address - Country:US
Practice Address - Phone:828-654-9299
Practice Address - Fax:828-654-9266
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-18
Last Update Date:2008-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC29158174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC891128KMedicaid
NCD27087Medicare UPIN
NC891128KMedicaid