Organization
MISSION HEALTH COMMUNITY MULTISPECIALTY PROVIDERS, LLC
Active
Parent organization
MISSION HEALTH COMMUNITY MULTISPECIALTY PROVIDERS, LLC
Other names
Dentist
Organization subpart
Yes
Provider details
NPI number
Legal business name
MISSION HEALTH COMMUNITY MULTISPECIALTY PROVIDERS, LLC
Authorized official
TEDRICK JOHNSON (GROUP VICE PRESIDENT)
(615) 372-3755
Entity
Organization
Contact information
Practice address
11 VANDERBILT PARK DR, ASHEVILLE, NC 28803-1700
(828) 213-1740
Mailing address
PO BOX 603366, CHARLOTTE, NC 28260-3366
(828) 213-1500
(828) 681-1575
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
02CG9
BC/BS NC
NC
05
—
1376013243
—
NC
Enumeration date
12/04/2018
Last updated
05/15/2020
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