Healthcare Provider Details

I. General information

NPI: 1619517976
Provider Name (Legal Business Name): MOUNTAIN COMMUNITY HEALTH PARTNERSHIP INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/14/2020
Last Update Date: 02/05/2025
Certification Date: 02/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

89 N MITCHELL AVE
BAKERSVILLE NC
28705-6502
US

IV. Provider business mailing address

116 SEVEN MILE RIDGE RD
BURNSVILLE NC
28714-8509
US

V. Phone/Fax

Practice location:
  • Phone: 828-688-2104
  • Fax:
Mailing address:
  • Phone: 828-675-4116
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: TIM EVANS
Title or Position: CEO
Credential:
Phone: 828-675-4116