Provider Demographics
NPI:1952389447
Name:ASHEVILLE INFECTIOUS DISEASE CONSULTANTS PA
Entity Type:Organization
Organization Name:ASHEVILLE INFECTIOUS DISEASE CONSULTANTS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:M
Authorized Official - Last Name:COOPER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-258-9635
Mailing Address - Street 1:53 S FRENCH BROAD AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28801-3272
Mailing Address - Country:US
Mailing Address - Phone:828-258-9635
Mailing Address - Fax:828-258-9682
Practice Address - Street 1:53 S FRENCH BROAD AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28801-3272
Practice Address - Country:US
Practice Address - Phone:828-258-9635
Practice Address - Fax:828-258-9682
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-04
Last Update Date:2010-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC39428174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8901235Medicaid
NC01235OtherBCBS PROVIDER NUMBER
NC230364Medicare ID - Type Unspecified