Provider Demographics
NPI:1609345685
Name:MOUNTAIN VISTA MEDICAL CENTER, LP
Entity Type:Organization
Organization Name:MOUNTAIN VISTA MEDICAL CENTER, LP
Other - Org Name:FLORENCE HOSPITAL, A CAMPUS OF MOUNTAIN VISTA MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:HOSPITAL PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JACOB
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-358-6100
Mailing Address - Street 1:1301 S CRISMON RD
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85209-3767
Mailing Address - Country:US
Mailing Address - Phone:480-358-6100
Mailing Address - Fax:480-358-6168
Practice Address - Street 1:4545 N HUNT HWY
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:AZ
Practice Address - Zip Code:85132-6937
Practice Address - Country:US
Practice Address - Phone:520-868-3333
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-19
Last Update Date:2019-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital