Provider Demographics
NPI:1629091020
Name:MOUNTAIN VIEW FAMILY PRACTICE
Entity Type:Organization
Organization Name:MOUNTAIN VIEW FAMILY PRACTICE
Other - Org Name:CLINICARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BILL
Authorized Official - Middle Name:
Authorized Official - Last Name:CARNS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-421-9711
Mailing Address - Street 1:680 E DEUCE OF CLUBS
Mailing Address - Street 2:SUITE A
Mailing Address - City:SHOW LOW
Mailing Address - State:AZ
Mailing Address - Zip Code:85901-4827
Mailing Address - Country:US
Mailing Address - Phone:928-537-9300
Mailing Address - Fax:928-537-0183
Practice Address - Street 1:680 E DEUCE OF CLUBS
Practice Address - Street 2:SUITE A
Practice Address - City:SHOW LOW
Practice Address - State:AZ
Practice Address - Zip Code:85901-4827
Practice Address - Country:US
Practice Address - Phone:928-537-9300
Practice Address - Fax:928-537-0183
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-26
Last Update Date:2008-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
2103759Medicare UPIN