Provider Demographics
NPI:1497994172
Name:NORTH MOUNTAIN DIETETIC SERVICES, LLC
Entity Type:Organization
Organization Name:NORTH MOUNTAIN DIETETIC SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED DIETITIAN
Authorized Official - Prefix:
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:S
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:540-331-5050
Mailing Address - Street 1:8006 SENEDO RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT JACKSON
Mailing Address - State:VA
Mailing Address - Zip Code:22842-2232
Mailing Address - Country:US
Mailing Address - Phone:540-477-4292
Mailing Address - Fax:
Practice Address - Street 1:8006 SENEDO RD
Practice Address - Street 2:
Practice Address - City:MOUNT JACKSON
Practice Address - State:VA
Practice Address - Zip Code:22842-2232
Practice Address - Country:US
Practice Address - Phone:540-477-4292
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-19
Last Update Date:2009-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty