Organization
MISSION HEALTH COMMUNITY MULTISPECIALTY PROVIDERS, LLC
Active
Parent organization
MISSION HEALTH COMMUNITY MULTISPECIALTY PROVIDERS, LLC
Other names
Olson Huff/MMA Psychiatric
Organization subpart
Yes
Provider details
NPI number
Legal business name
MISSION HEALTH COMMUNITY MULTISPECIALTY PROVIDERS, LLC
Authorized official
WILLIAM TEDERICK JOHNSON (GROUP VP/AUTHORIZED OFFICIAL)
(615) 372-3375
Entity
Organization
Contact information
Practice address
11 VANDERBILT PARK DR, ASHEVILLE, NC 28803-1700
(828) 213-1700
Mailing address
PO BOX 603366, CHARLOTTE, NC 28260-3366
(828) 213-1500
(828) 681-1575
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
—
—
2084P0800X
Psychiatry Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
02CG9
BC/BS NC
NC
05
—
1003386228
—
NC
Enumeration date
11/30/2018
Last updated
05/15/2020
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