Healthcare Provider Details

I. General information

NPI: 1609856590
Provider Name (Legal Business Name): MOUNTAIN MEDICAL ARTS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 S MAIN ST
BURNSVILLE NC
28714-2929
US

IV. Provider business mailing address

PO BOX 1240
BURNSVILLE NC
28714-1240
US

V. Phone/Fax

Practice location:
  • Phone: 828-678-9352
  • Fax: 828-682-7866
Mailing address:
  • Phone: 828-678-9352
  • Fax: 828-682-7866

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberNC200301048
License Number StateNC

VIII. Authorized Official

Name: DR. KELLY SUE ROTHE
Title or Position: PHYSICIAN
Credential: D.O.
Phone: 828-678-9352