Provider Demographics
NPI:1538538509
Name:MUSTARD SEED COMMUNITY HEALTH
Entity type:Organization
Organization Name:MUSTARD SEED COMMUNITY HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:MULBERRY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:336-314-5489
Mailing Address - Street 1:238 S ENGLISH ST
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27401-3648
Mailing Address - Country:US
Mailing Address - Phone:336-763-0814
Mailing Address - Fax:336-763-8709
Practice Address - Street 1:238 S ENGLISH ST
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401-3648
Practice Address - Country:US
Practice Address - Phone:336-763-0814
Practice Address - Fax:336-763-0815
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-21
Last Update Date:2018-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200001414208000000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty