Healthcare Provider Details

I. General information

NPI: 1649416058
Provider Name (Legal Business Name): MOSAIC COMPREHENSIVE CARE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/07/2009
Last Update Date: 05/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1240 ENVIRON WAY
CHAPEL HILL NC
27517
US

IV. Provider business mailing address

1240 ENVIRON WAY
CHAPEL HILL NC
27517
US

V. Phone/Fax

Practice location:
  • Phone: 919-240-7269
  • Fax: 919-240-7816
Mailing address:
  • Phone: 919-240-7269
  • Fax: 919-240-7816

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number2008-01086
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number30300
License Number StateNC

VIII. Authorized Official

Name: DR. LOUISE DYSART METZ
Title or Position: OWNER (SOLE OWNER)
Credential: MD
Phone: 919-240-7269