Provider Demographics
NPI:1942291802
Name:MOUNTAIN SURGICAL ASSOCIATES
Entity Type:Organization
Organization Name:MOUNTAIN SURGICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:J
Authorized Official - Last Name:NOELL
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:828-586-7466
Mailing Address - Street 1:PO BOX 638
Mailing Address - Street 2:
Mailing Address - City:SYLVA
Mailing Address - State:NC
Mailing Address - Zip Code:28779-0638
Mailing Address - Country:US
Mailing Address - Phone:828-586-7466
Mailing Address - Fax:828-586-4512
Practice Address - Street 1:37 MEDICAL PARK LOOP
Practice Address - Street 2:SUITE 103
Practice Address - City:SYLVA
Practice Address - State:NC
Practice Address - Zip Code:28779-5289
Practice Address - Country:US
Practice Address - Phone:828-586-7466
Practice Address - Fax:828-586-4512
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890222BMedicaid
NC2316783AMedicare ID - Type Unspecified
NC890222BMedicaid