Provider Demographics
NPI:1548412950
Name:NORTH MOUNTAIN FAMILY MEDICINE PLLC
Entity Type:Organization
Organization Name:NORTH MOUNTAIN FAMILY MEDICINE PLLC
Other - Org Name:NORTH MOUNTAIN FAMILY MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BIRCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-246-0351
Mailing Address - Street 1:3805 E BELL ROAD
Mailing Address - Street 2:ST. 5300
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032
Mailing Address - Country:US
Mailing Address - Phone:602-246-0351
Mailing Address - Fax:602-246-7023
Practice Address - Street 1:3805 E BELL ROAD
Practice Address - Street 2:ST. 5300
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032
Practice Address - Country:US
Practice Address - Phone:602-246-0351
Practice Address - Fax:602-246-7023
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-16
Last Update Date:2019-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ126189Medicare PIN