Provider Demographics
NPI:1083774871
Name:MOUNTAIN VIEW FAMILY MEDICINE
Entity Type:Organization
Organization Name:MOUNTAIN VIEW FAMILY MEDICINE
Other - Org Name:GURLEY MEDICAL CLINIC
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR OF PHYSICIANS NETWORK
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:
Authorized Official - Last Name:MASON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-265-7791
Mailing Address - Street 1:PO BOX 127
Mailing Address - Street 2:
Mailing Address - City:GURLEY
Mailing Address - State:AL
Mailing Address - Zip Code:35748-0127
Mailing Address - Country:US
Mailing Address - Phone:256-776-2094
Mailing Address - Fax:256-776-0047
Practice Address - Street 1:5995 HWY 72 EAST
Practice Address - Street 2:
Practice Address - City:GURLEY
Practice Address - State:AL
Practice Address - Zip Code:35748-0127
Practice Address - Country:US
Practice Address - Phone:256-776-2094
Practice Address - Fax:256-776-0047
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2014-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL540003415Medicaid
AL013415Medicare Oscar/Certification