Provider Demographics
NPI:1467809657
Name:MOUNTAIN VIEW NEUROCARE, LLC
Entity Type:Organization
Organization Name:MOUNTAIN VIEW NEUROCARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MINDY
Authorized Official - Middle Name:
Authorized Official - Last Name:WAKEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CNIM
Authorized Official - Phone:970-405-0319
Mailing Address - Street 1:PO BOX 503
Mailing Address - Street 2:
Mailing Address - City:MILLIKEN
Mailing Address - State:CO
Mailing Address - Zip Code:80543-0503
Mailing Address - Country:US
Mailing Address - Phone:970-405-0319
Mailing Address - Fax:
Practice Address - Street 1:592 TRAILDUST DR
Practice Address - Street 2:
Practice Address - City:MILLIKEN
Practice Address - State:CO
Practice Address - Zip Code:80543-3030
Practice Address - Country:US
Practice Address - Phone:970-405-0319
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-18
Last Update Date:2016-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes284300000XHospitalsSpecial Hospital
No246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnosticGroup - Single Specialty