Provider Demographics
NPI:1417935438
Name:MONTE VISTA FAMILY PRACTICE
Entity Type:Organization
Organization Name:MONTE VISTA FAMILY PRACTICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:PINKERTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:719-852-9400
Mailing Address - Street 1:103 CHICO CT
Mailing Address - Street 2:
Mailing Address - City:MONTE VISTA
Mailing Address - State:CO
Mailing Address - Zip Code:81144-1065
Mailing Address - Country:US
Mailing Address - Phone:719-852-9400
Mailing Address - Fax:
Practice Address - Street 1:103 CHICO CT
Practice Address - Street 2:
Practice Address - City:MONTE VISTA
Practice Address - State:CO
Practice Address - Zip Code:81144-1065
Practice Address - Country:US
Practice Address - Phone:719-852-9400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-09
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO18959253Medicaid
CO1314530001Medicare NSC
CO18959253Medicaid