Organization
MISSION COMMUNITY ANESTHESIOLOGY SPECIALISTS LLC
Active
Parent organization
MISSION COMMUNITY ANESTHESIOLOGY SPECIALISTS LLC
Other names
Gastroenterology
Organization subpart
Yes
Provider details
NPI number
Legal business name
MISSION COMMUNITY ANESTHESIOLOGY SPECIALISTS LLC
Authorized official
MARILYN TATHAM DO (PROVIDER ENROLLMENT MANAGER)
(828) 651-6595
Entity
Organization
Contact information
Practice address
2695 HENDERSONVILLE RD STE 206, ARDEN, NC 28704-8576
(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
207RG0100X
Gastroenterology Physician
Primary
—
—
2080P0206X
Pediatric Gastroenterology Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
02CG9
BC/BS NC
NC
Enumeration date
11/28/2018
Last updated
11/28/2018
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