Organization
MISSION COMMUNITY ANESTHESIOLOGY SPECIALISTS LLC
Active
Parent organization
MISSION COMMUNITY ANESTHESIOLOGY SPECIALISTS LLC
Other names
Pediatric
Organization subpart
Yes
Provider details
NPI number
Legal business name
MISSION COMMUNITY ANESTHESIOLOGY SPECIALISTS LLC
Authorized official
MARILYN TATHAM (PROVIDER ENROLLMENT MANAGER)
(828) 651-6595
Entity
Organization
Contact information
Practice address
11 VANDERBILT PARK DRIVE, ASHEVILLE, NC 28803
(828) 213-1740
Mailing address
PO BOX 603366, CHARLOTTE, NC 28260-2373
(828) 681-1575
Taxonomy
Speciality
Code
Description
License number
State
207SG0201X
Clinical Genetics (M.D.) Physician
—
—
208000000X
Pediatrics Physician
Primary
—
—
2080N0001X
Neonatal-Perinatal Medicine Physician
—
—
2080P0202X
Pediatric Cardiology Physician
—
—
2080P0203X
Pediatric Critical Care Medicine Physician
—
—
2080P0206X
Pediatric Gastroenterology Physician
—
—
2080P0207X
Pediatric Hematology & Oncology Physician
—
—
2084P0804X
Child & Adolescent Psychiatry Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
027N4
BC/BS OF NC
NC
01
—
02CG9
BC/BS OF NC
NC
Enumeration date
11/27/2018
Last updated
12/05/2018
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