Provider Demographics
NPI:1467109488
Name:MOUNTAIN VISTA MEDICAL CENTER, LP
Entity Type:Organization
Organization Name:MOUNTAIN VISTA MEDICAL CENTER, LP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER ENROLLMENT
Authorized Official - Prefix:
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:ATKINSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-331-7514
Mailing Address - Street 1:5750 E BASELINE RD
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85206-4806
Mailing Address - Country:US
Mailing Address - Phone:520-868-3333
Mailing Address - Fax:520-509-2852
Practice Address - Street 1:5750 E BASELINE RD
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-4806
Practice Address - Country:US
Practice Address - Phone:520-868-3333
Practice Address - Fax:520-509-2852
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-09
Last Update Date:2022-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital