Provider Demographics
NPI:1417003336
Name:MOUNTAINVIEW HEAD & NECK SURGEONS, PC
Entity Type:Organization
Organization Name:MOUNTAINVIEW HEAD & NECK SURGEONS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HELEN
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:WATT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-368-9608
Mailing Address - Street 1:38245 N JACQUELINE DR
Mailing Address - Street 2:#3
Mailing Address - City:CAVE CREEK
Mailing Address - State:AZ
Mailing Address - Zip Code:85331-8516
Mailing Address - Country:US
Mailing Address - Phone:480-368-9608
Mailing Address - Fax:
Practice Address - Street 1:38245 N JACQUELINE DR
Practice Address - Street 2:#3
Practice Address - City:CAVE CREEK
Practice Address - State:AZ
Practice Address - Zip Code:85331-8516
Practice Address - Country:US
Practice Address - Phone:480-368-9608
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2018-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ22016133N00000X, 208600000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No133N00000XDietary & Nutritional Service ProvidersNutritionistGroup - Multi-Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ158619Medicaid
AZZ114383Medicare PIN
AZ158619Medicaid