Provider Demographics
NPI:1275730749
Name:MOUNTAIN VIEW MEDICAL, LLC
Entity Type:Organization
Organization Name:MOUNTAIN VIEW MEDICAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NELSON
Authorized Official - Middle Name:LAFARR
Authorized Official - Last Name:ASTLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD,
Authorized Official - Phone:801-774-8888
Mailing Address - Street 1:2122 W 1800 N PMB 413
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:UT
Mailing Address - Zip Code:84015-7923
Mailing Address - Country:US
Mailing Address - Phone:801-774-8888
Mailing Address - Fax:
Practice Address - Street 1:2122 WEST 1800 NORTH PMB 413
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:UT
Practice Address - Zip Code:84015
Practice Address - Country:US
Practice Address - Phone:801-774-8888
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-28
Last Update Date:2007-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service