Healthcare Provider Details

I. General information

NPI: 1790408771
Provider Name (Legal Business Name): MOUNTAIN COMMUNITY HEALTH PARTNERSHIP INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2022
Last Update Date: 03/13/2024
Certification Date: 03/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

621 MICAVILLE LOOP STE 600
BURNSVILLE NC
28714-0828
US

IV. Provider business mailing address

PO BOX 27
BAKERSVILLE NC
28705-0027
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

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