Provider Demographics
NPI:1487857728
Name:MOUNTAIN VIEW FAMILY PRACTICE
Entity Type:Organization
Organization Name:MOUNTAIN VIEW FAMILY PRACTICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:W
Authorized Official - Last Name:PHARES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:304-754-7160
Mailing Address - Street 1:3790 HEDGESVILLE RD STE H
Mailing Address - Street 2:
Mailing Address - City:HEDGESVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:25427-6704
Mailing Address - Country:US
Mailing Address - Phone:304-754-7160
Mailing Address - Fax:304-754-7244
Practice Address - Street 1:3790 HEDGESVILLE RD STE H
Practice Address - Street 2:
Practice Address - City:HEDGESVILLE
Practice Address - State:WV
Practice Address - Zip Code:25427-6704
Practice Address - Country:US
Practice Address - Phone:304-754-7160
Practice Address - Fax:304-754-7244
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-06
Last Update Date:2010-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV21259261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV2005711000Medicaid
H51362Medicare UPIN