# MOUNTAIN MEDICAL ARTS PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1609856590
- **Authorized official:** DR. KELLY SUE ROTHE D.O. (PHYSICIAN)
- **Authorized official phone:** (828) 678-9352

## Contact information

- **Practice address:** 2 S MAIN ST, BURNSVILLE, NC 28714-2929
- **Practice address phone:** (828) 678-9352
- **Practice address fax:** (828) 682-7866
- **Mailing address:** PO BOX 1240, BURNSVILLE, NC 28714-1240
- **Mailing address phone:** (828) 678-9352
- **Mailing address fax:** (828) 682-7866

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | NC200301048 | NC | Yes |

## Other

- **Enumeration date:** 01/18/2006
- **Last updated:** 03/07/2023

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 135R4 | BLUE CROSS BLUE SHEILD | NC |
| 05 | — | 89135R4 | — | NC |
| 01 | — | NC200301048 | STATE LICENCE \# | NC |
| 01 | — | P00252272 | PERSONAL MEDICARE \# | NC |