Provider Demographics
NPI:1508166752
Name:MOUNTAIN VIEW PRIMARY CARE INC
Entity Type:Organization
Organization Name:MOUNTAIN VIEW PRIMARY CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT / OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:BOSTAPH
Authorized Official - Suffix:
Authorized Official - Credentials:CRNP
Authorized Official - Phone:240-522-8250
Mailing Address - Street 1:1602 FORD AVE
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21502-4612
Mailing Address - Country:US
Mailing Address - Phone:301-759-4544
Mailing Address - Fax:301-723-4446
Practice Address - Street 1:1602 FORD AVE
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:MD
Practice Address - Zip Code:21502-4612
Practice Address - Country:US
Practice Address - Phone:301-759-4544
Practice Address - Fax:301-723-4446
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-21
Last Update Date:2016-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR087737261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care