Provider Demographics
NPI:1245317130
Name:VISTA FAMILY HEALTH PA
Entity type:Organization
Organization Name:VISTA FAMILY HEALTH PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:FIELDS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:828-687-8647
Mailing Address - Street 1:2585 HENDERSONVILLE RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:ARDEN
Mailing Address - State:NC
Mailing Address - Zip Code:28704-9577
Mailing Address - Country:US
Mailing Address - Phone:828-687-8647
Mailing Address - Fax:828-684-6891
Practice Address - Street 1:2585 HENDERSONVILLE RD
Practice Address - Street 2:SUITE C
Practice Address - City:ARDEN
Practice Address - State:NC
Practice Address - Zip Code:28704-9577
Practice Address - Country:US
Practice Address - Phone:828-687-8647
Practice Address - Fax:828-684-6891
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2010-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200101201208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89014T0Medicaid
NC89014T0Medicaid