Provider Demographics
NPI:1457535478
Name:FORGE MOUNTAIN MEDICINE, PLLC
Entity Type:Organization
Organization Name:FORGE MOUNTAIN MEDICINE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:L
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:828-890-3883
Mailing Address - Street 1:127 VANCE HILL DR
Mailing Address - Street 2:
Mailing Address - City:MILLS RIVER
Mailing Address - State:NC
Mailing Address - Zip Code:28759-4996
Mailing Address - Country:US
Mailing Address - Phone:828-890-3883
Mailing Address - Fax:828-890-3100
Practice Address - Street 1:127 VANCE HILL DR
Practice Address - Street 2:
Practice Address - City:MILLS RIVER
Practice Address - State:NC
Practice Address - Zip Code:28759-4996
Practice Address - Country:US
Practice Address - Phone:828-890-3883
Practice Address - Fax:828-890-3100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-27
Last Update Date:2010-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9800701174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5903035Medicaid
NC2349105Medicare PIN