Provider Demographics
NPI:1407269459
Name:MOUNTAIN VIEW DIABETES CARE
Entity Type:Organization
Organization Name:MOUNTAIN VIEW DIABETES CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HAYLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:206-459-0334
Mailing Address - Street 1:189 E FORT UNION BLVD STE 103
Mailing Address - Street 2:
Mailing Address - City:MIDVALE
Mailing Address - State:UT
Mailing Address - Zip Code:84047-4800
Mailing Address - Country:US
Mailing Address - Phone:801-822-3315
Mailing Address - Fax:
Practice Address - Street 1:189 E FORT UNION BLVD STE 103
Practice Address - Street 2:
Practice Address - City:MIDVALE
Practice Address - State:UT
Practice Address - Zip Code:84047-4800
Practice Address - Country:US
Practice Address - Phone:801-822-3315
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-07
Last Update Date:2014-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7994652-1205207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty