Provider Demographics
NPI:1811168065
Name:MOUNTAIN NEUROSURGICAL & SPINE CENTER PA
Entity type:Organization
Organization Name:MOUNTAIN NEUROSURGICAL & SPINE CENTER PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:
Authorized Official - Last Name:FLEMING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-225-7776
Mailing Address - Street 1:PO BOX 25370
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28813-1370
Mailing Address - Country:US
Mailing Address - Phone:828-255-7776
Mailing Address - Fax:828-274-5134
Practice Address - Street 1:511 6TH AVE W
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28739-3501
Practice Address - Country:US
Practice Address - Phone:828-692-2099
Practice Address - Fax:828-692-2799
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-17
Last Update Date:2008-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Multi-Specialty
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5902748Medicaid
NC0509Medicare PIN