Provider Demographics
NPI:1417982547
Name:MOUNTAINVIEW MEDICAL
Entity Type:Organization
Organization Name:MOUNTAINVIEW MEDICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EMPLOYEE
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:W
Authorized Official - Last Name:VALENTINE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:802-225-5400
Mailing Address - Street 1:195 HOSPITAL LOOP
Mailing Address - Street 2:SUITE 3
Mailing Address - City:BERLIN
Mailing Address - State:VT
Mailing Address - Zip Code:05602-9522
Mailing Address - Country:US
Mailing Address - Phone:802-225-5400
Mailing Address - Fax:802-225-5401
Practice Address - Street 1:195 HOSPITAL LOOP
Practice Address - Street 2:SUITE 3
Practice Address - City:BERLIN
Practice Address - State:VT
Practice Address - Zip Code:05602-9522
Practice Address - Country:US
Practice Address - Phone:802-225-5400
Practice Address - Fax:802-225-5401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-11
Last Update Date:2010-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT0VN0786Medicaid
VT0183880001Medicare NSC
VTVN0786Medicare ID - Type Unspecified