Healthcare Provider Details

I. General information

NPI: 1114497344
Provider Name (Legal Business Name): MISSION COMMUNITY ANESTHESIOLOGY SPECIALISTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2018
Last Update Date: 12/03/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 HOSPITAL DR STE 4100
ASHEVILLE NC
28801-4550
US

IV. Provider business mailing address

PO BOX 603366
CHARLOTTE NC
28260-3366
US

V. Phone/Fax

Practice location:
  • Phone: 828-213-1740
  • Fax:
Mailing address:
  • Phone:
  • Fax: 828-681-1575

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name: CAROL HILL
Title or Position: PROVIDER ENROLLMENT SPECIALIST
Credential:
Phone: 828-651-6579