Provider Demographics
NPI:1073970059
Name:MOUNTAIN MEDICAL MANAGEMENT, LLC
Entity Type:Organization
Organization Name:MOUNTAIN MEDICAL MANAGEMENT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INITIAL MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:ERIKA
Authorized Official - Middle Name:T
Authorized Official - Last Name:HUSTON
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:520-906-7904
Mailing Address - Street 1:1888 N COUNTRY CLUB RD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85716-3115
Mailing Address - Country:US
Mailing Address - Phone:520-327-6367
Mailing Address - Fax:520-318-4492
Practice Address - Street 1:1888 N COUNTRY CLUB RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85716-3115
Practice Address - Country:US
Practice Address - Phone:520-327-6367
Practice Address - Fax:520-318-4492
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-21
Last Update Date:2016-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0683213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty