Provider Demographics
NPI:1144405200
Name:MOUNTAIN VIEW MEDICAL GROUP, PC
Entity Type:Organization
Organization Name:MOUNTAIN VIEW MEDICAL GROUP, PC
Other - Org Name:THE WALKING CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:SOL
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:719-635-7700
Mailing Address - Street 1:5575 TECH CENTER DR
Mailing Address - Street 2:STE 106
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80919-2353
Mailing Address - Country:US
Mailing Address - Phone:719-590-1177
Mailing Address - Fax:719-590-1360
Practice Address - Street 1:5014 EL CAMINO DR
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-2104
Practice Address - Country:US
Practice Address - Phone:719-635-7700
Practice Address - Fax:719-635-1794
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-08
Last Update Date:2014-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC55673Medicare PIN
COT60245Medicare UPIN
CO0437020001Medicare NSC
CO0437020001Medicare NSC