Provider Demographics
NPI:1235783994
Name:MOUNTAIN TOP MEDICAL, PLLC
Entity Type:Organization
Organization Name:MOUNTAIN TOP MEDICAL, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:C
Authorized Official - Last Name:SHAW
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:435-515-3030
Mailing Address - Street 1:140 E 1000 S STE B2
Mailing Address - Street 2:
Mailing Address - City:BRIGHAM CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84302-4399
Mailing Address - Country:US
Mailing Address - Phone:435-515-3030
Mailing Address - Fax:435-515-3434
Practice Address - Street 1:140 E 1000 S STE B2
Practice Address - Street 2:
Practice Address - City:BRIGHAM CITY
Practice Address - State:UT
Practice Address - Zip Code:84302-4399
Practice Address - Country:US
Practice Address - Phone:435-515-3030
Practice Address - Fax:435-515-3434
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-30
Last Update Date:2019-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty