Provider Demographics
NPI:1215941679
Name:WESTERN CAROLINA MEDICAL ASSOC., INC.
Entity type:Organization
Organization Name:WESTERN CAROLINA MEDICAL ASSOC., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:
Authorized Official - Last Name:HOUSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-696-1000
Mailing Address - Street 1:741 6TH AVE W
Mailing Address - Street 2:
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28739-4113
Mailing Address - Country:US
Mailing Address - Phone:828-694-7630
Mailing Address - Fax:
Practice Address - Street 1:741 6TH AVE W
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28739-4113
Practice Address - Country:US
Practice Address - Phone:828-694-7630
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89012PMMedicare ID - Type Unspecified
NC230050Medicare ID - Type Unspecified