Provider Demographics
NPI:1952522179
Name:MOUNTAIN DIABETES AND ENDOCRINE CENTER PLLC
Entity Type:Organization
Organization Name:MOUNTAIN DIABETES AND ENDOCRINE CENTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:LOUIS
Authorized Official - Last Name:WEINRIB
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:828-684-9588
Mailing Address - Street 1:1998 HENDERSONVILLE RD
Mailing Address - Street 2:SUITE 31
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28803-2349
Mailing Address - Country:US
Mailing Address - Phone:828-684-9588
Mailing Address - Fax:828-684-9626
Practice Address - Street 1:1998 HENDERSONVILLE RD
Practice Address - Street 2:SUITE 31
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28803-2349
Practice Address - Country:US
Practice Address - Phone:828-684-9588
Practice Address - Fax:828-684-9626
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-02
Last Update Date:2015-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC012E3OtherBCBS GROUP NUMBER
NC89012E3Medicaid
NC012E3OtherBCBS GROUP NUMBER