Provider Demographics
NPI:1609123512
Name:MOUNTAIN VISTA MEDICINE
Entity Type:Organization
Organization Name:MOUNTAIN VISTA MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MIKE
Authorized Official - Middle Name:T
Authorized Official - Last Name:SWINYARD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:801-838-9090
Mailing Address - Street 1:1258 W SOUTH JORDAN PKWY
Mailing Address - Street 2:103
Mailing Address - City:SOUTH JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84095-4711
Mailing Address - Country:US
Mailing Address - Phone:801-838-9090
Mailing Address - Fax:801-838-9092
Practice Address - Street 1:1258 W SOUTH JORDAN PKWY
Practice Address - Street 2:103
Practice Address - City:SOUTH JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84095
Practice Address - Country:US
Practice Address - Phone:801-838-9090
Practice Address - Fax:801-838-9092
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-09
Last Update Date:2018-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT292580-12052080P0205X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0205XAllopathic & Osteopathic PhysiciansPediatricsPediatric EndocrinologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1245222819OtherINDIVDUAL NPI