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General NPI Number Information
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NPI Number | 1609856590
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Entity Type | Organization
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Legal Business Name | MOUNTAIN MEDICAL ARTS PLLC
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Dates
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Enumeration Date | 01/18/2006
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 2 S MAIN ST
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City | BURNSVILLE
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State | NC
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Zip | 28714-2929
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Country | US
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Telephone | 828-678-9352
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Fax | 828-682-7866
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Provider Business Mailing Address
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Address Line | PO BOX 1240
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City | BURNSVILLE
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State | NC
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Zip | 28714-1240
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Country | US
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Telephone | 828-678-9352
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Fax | 828-682-7866
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. KELLY SUE ROTHE
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Credential | D.O.
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Telephone | 828-678-9352
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | NC200301048
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License Number State | NC
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