Provider Demographics
NPI:1225170897
Name:MOUNTAIN VIEW MEDICAL CENTER
Entity Type:Organization
Organization Name:MOUNTAIN VIEW MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:D
Authorized Official - Last Name:CLEARY
Authorized Official - Suffix:
Authorized Official - Credentials:PRACTICE MANAGER
Authorized Official - Phone:336-696-2711
Mailing Address - Street 1:PO BOX 82
Mailing Address - Street 2:
Mailing Address - City:HAYS
Mailing Address - State:NC
Mailing Address - Zip Code:28635
Mailing Address - Country:US
Mailing Address - Phone:336-696-2711
Mailing Address - Fax:336-696-2829
Practice Address - Street 1:5229 ROCK CREEK RD
Practice Address - Street 2:
Practice Address - City:HAYS
Practice Address - State:NC
Practice Address - Zip Code:28635
Practice Address - Country:US
Practice Address - Phone:336-696-2711
Practice Address - Fax:336-696-2829
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-12
Last Update Date:2008-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC343847AMedicaid
NC343847CMedicaid
G19938Medicare UPIN
P98501Medicare UPIN
E12028Medicare UPIN
2804293Medicare ID - Type Unspecified
NC343847CMedicaid
NC343847Medicare Oscar/Certification