Provider Demographics
NPI:1063476968
Name:MOUNTAIN VALLEY ORTHOPEDICS, PLLC
Entity Type:Organization
Organization Name:MOUNTAIN VALLEY ORTHOPEDICS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:FREE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-837-9181
Mailing Address - Street 1:145 MEDICAL PARK LN
Mailing Address - Street 2:SUITE I
Mailing Address - City:MURPHY
Mailing Address - State:NC
Mailing Address - Zip Code:28906-6850
Mailing Address - Country:US
Mailing Address - Phone:828-837-3781
Mailing Address - Fax:828-835-3486
Practice Address - Street 1:145 MEDICAL PARK LN
Practice Address - Street 2:SUITE I
Practice Address - City:MURPHY
Practice Address - State:NC
Practice Address - Zip Code:28906-6850
Practice Address - Country:US
Practice Address - Phone:828-837-3781
Practice Address - Fax:828-835-3486
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-17
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2006-00132207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1418YOtherBCBS
NC5905627Medicaid
NC5905627Medicaid