Organization
EXTENDED CARE PHYSICIANS - MOUNTAIN, PA
Active
Other names
ECP North Carolina, PA
Organization subpart
No
Provider details
NPI number
Authorized official
ROBIN GLEESON-WARREN (CREDENTIALING DIRECTOR)
(828) 277-4810
Entity
Organization
Contact information
Practice address
90 SOUTHSIDE AVE, SUITE 300, ASHEVILLE, NC 28801-4160
(828) 277-4810
Mailing address
PO BOX 890291, CHARLOTTE, NC 28289-0291
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
207QG0300X
Geriatric Medicine (Family Medicine) Physician
—
—
207R00000X
Internal Medicine Physician
—
—
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
Primary
200201376
NC
2084P0805X
Geriatric Psychiatry Physician
—
—
208D00000X
General Practice Physician
—
—
363A00000X
Physician Assistant
—
—
363L00000X
Nurse Practitioner
—
—
363LA2100X
Acute Care Nurse Practitioner
86999
NC
363LA2200X
Adult Health Nurse Practitioner
86999
NC
363LF0000X
Family Nurse Practitioner
—
—
363LG0600X
Gerontology Nurse Practitioner
—
—
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
011JK
BCBSNC
NC
01
—
56162
MEDCOST
NC
05
—
89011JK
—
NC
01
—
CG9205
RAILROAD MEDICARE
NC
Enumeration date
07/07/2005
Last updated
04/16/2015
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