Provider Demographics
NPI:1811207418
Name:MINT HILL PRIMARY CARE PLLC
Entity type:Organization
Organization Name:MINT HILL PRIMARY CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:B
Authorized Official - Last Name:WHALEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:704-545-6400
Mailing Address - Street 1:11304 HAWTHORNE DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MINT HILL
Mailing Address - State:NC
Mailing Address - Zip Code:28227-9437
Mailing Address - Country:US
Mailing Address - Phone:704-545-6400
Mailing Address - Fax:704-377-7656
Practice Address - Street 1:11304 HAWTHORNE DR
Practice Address - Street 2:SUITE 100
Practice Address - City:MINT HILL
Practice Address - State:NC
Practice Address - Zip Code:28227-9437
Practice Address - Country:US
Practice Address - Phone:704-545-6400
Practice Address - Fax:704-377-7656
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-15
Last Update Date:2010-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC168432207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty