Provider Demographics
NPI:1164557088
Name:MOUNTAIN VIEW FAMILY MEDICINE
Entity Type:Organization
Organization Name:MOUNTAIN VIEW FAMILY MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:TAMLYN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-221-3855
Mailing Address - Street 1:2121 E HARMONY RD
Mailing Address - Street 2:# 310
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80528-3400
Mailing Address - Country:US
Mailing Address - Phone:970-221-3855
Mailing Address - Fax:970-212-1238
Practice Address - Street 1:2121 E HARMONY RD
Practice Address - Street 2:# 310
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80528-3400
Practice Address - Country:US
Practice Address - Phone:970-221-3855
Practice Address - Fax:970-212-1238
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04020186Medicaid
CO04020186Medicaid