Provider Demographics
NPI:1285722801
Name:MOUNTAIN AREA FAMILY MEDICINE, PA
Entity type:Organization
Organization Name:MOUNTAIN AREA FAMILY MEDICINE, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:WHEELER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:828-743-2491
Mailing Address - Street 1:PO BOX 1828
Mailing Address - Street 2:
Mailing Address - City:CASHIERS
Mailing Address - State:NC
Mailing Address - Zip Code:28717-1828
Mailing Address - Country:US
Mailing Address - Phone:828-743-2491
Mailing Address - Fax:828-743-3060
Practice Address - Street 1:57 WHITE OWL LANE
Practice Address - Street 2:
Practice Address - City:CASHIERS
Practice Address - State:NC
Practice Address - Zip Code:28717-0000
Practice Address - Country:US
Practice Address - Phone:828-743-2491
Practice Address - Fax:828-743-3060
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-10
Last Update Date:2009-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC63833261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
1013952928OtherNPI
1649202383OtherNPI
1801824784OtherNPI
NC8941098Medicaid
NC8986731Medicaid
NC890222XMedicaid
NCC81403Medicare UPIN
NC202666BMedicare ID - Type Unspecified
NC8941098Medicaid
1801824784OtherNPI
NCS50248Medicare UPIN
2319515Medicare ID - Type Unspecified
NC204105EMedicare ID - Type Unspecified