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General NPI Number Information
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NPI Number | 1104823087
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Entity Type | Organization
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Legal Business Name | EXTENDED CARE PHYSICIANS - MOUNTAIN, PA
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Dates
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Enumeration Date | 07/07/2005
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Last Update Date | 04/16/2015
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Provider Practice Location Address
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Address Line | 90 SOUTHSIDE AVE SUITE 300
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City | ASHEVILLE
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State | NC
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Zip | 28801-4160
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Country | US
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Telephone | 828-277-4810
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 890291
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City | CHARLOTTE
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State | NC
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Zip | 28289-0291
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CREDENTIALING DIRECTOR
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Name | ROBIN GLEESON-WARREN
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Credential |
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Telephone | 828-277-4810
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QG0300X
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Taxonomy Name | Geriatric Medicine (Family Medicine) Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2084P0805X
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Taxonomy Name | Geriatric Psychiatry Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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Taxonomy #8
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #9
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #10
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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Taxonomy #11
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 86999
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License Number State | NC
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Taxonomy #12
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Taxonomy Code | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | 86999
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License Number State | NC
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Taxonomy #13
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Taxonomy Code | 207RG0300X
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Taxonomy Name | Geriatric Medicine (Internal Medicine) Physician
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License Number | 200201376
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License Number State | NC
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