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General NPI Number Information
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NPI Number | 1255417358
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Entity Type | Organization
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Legal Business Name | MOUNTAIN LAUREL INTERNAL MEDICINE,PA
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Dates
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Enumeration Date | 10/31/2006
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Last Update Date | 07/31/2024
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Provider Practice Location Address
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Address Line | 2139 LINVILLE FALLS HWY
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City | LINVILLE
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State | NC
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Zip | 28646
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Country | US
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Telephone | 828-733-0270
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Fax | 828-733-9271
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Provider Business Mailing Address
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Address Line | PO BOX 1045
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City | LINVILLE
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State | NC
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Zip | 28646-1045
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Country | US
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Telephone | 828-733-0270
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Fax | 828-733-9271
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Authorized Official
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Title or Position | BUSINESS MANAGER
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Name | STEPHEN LEE BAILEY
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Credential | RN
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Telephone | 828-733-0270
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 36648
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License Number State | NC
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Taxonomy #2
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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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