NPIMap

Organization Active NPI

Mission Health Community Multispecialty Providers, LLC

  • Dentist
  • Asheville, NC
National Provider Identifier
1376013243
Registry record updated May 15, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
Legal business name
MISSION HEALTH COMMUNITY MULTISPECIALTY PROVIDERS, LLC
Practice address
11 Vanderbilt Park Dr
Asheville, NC 28803-1700
Phone
(828) 213-1740
NPI assigned
Dec 4, 2018
Organization subpart
Yes
Parent organization
MISSION HEALTH COMMUNITY MULTISPECIALTY PROVIDERS, LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on May 15, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Tedrick Johnson
Title
Group Vice President
Phone
(615) 372-3755

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193200000X MULTI-SPECIALTY GROUP 122300000X Primary

Addresses

Primary practice location

11 Vanderbilt Park Dr
Asheville, NC 28803-1700

Mailing address

PO Box 603366
Charlotte, NC 28260-3366
Phone (828) 213-1500

Other identifiers 2

IdentifierTypeStateIssuer
02CG9OtherNCBC/BS NC
1376013243MedicaidNC

Other names 1

  • Dentist Other name

National Provider Directory

National Provider Directory
Tax ID family
Mission Health Community Multispecialty Providers LLC23 organizations share this tax ID, including this one
Part of
Mission Health Community Multispecialty Providers LLC

Other organizations with this tax ID 22

Organizations that report the same tax identification number in the National Provider Directory.

View all 22

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1543881600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1589500800000",
    "number": "1376013243",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 603366",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282603366",
            "telephone_number": "828-213-1500",
            "fax_number": "828-681-1575"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11 VANDERBILT PARK DR",
            "city": "ASHEVILLE",
            "state": "NC",
            "postal_code": "288031700",
            "telephone_number": "828-213-1740"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MISSION HEALTH COMMUNITY MULTISPECIALTY PROVIDERS, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MISSION HEALTH COMMUNITY MULTISPECIALTY PROVIDERS, LLC",
        "enumeration_date": "2018-12-04",
        "last_updated": "2020-05-15",
        "certification_date": "2020-05-15",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "TEDRICK",
        "authorized_official_title_or_position": "GROUP VICE PRESIDENT",
        "authorized_official_telephone_number": "615-372-3755"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC/BS NC",
            "identifier": "02CG9",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1376013243",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Dentist",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Dentist",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Asheville, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 15, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.