Provider Demographics
NPI:1629499421
Name:MOUNTAIN VISTA PAIN MANAGEMENT LLC
Entity Type:Organization
Organization Name:MOUNTAIN VISTA PAIN MANAGEMENT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:
Authorized Official - Last Name:DOWNS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:480-874-9800
Mailing Address - Street 1:1375 N SCOTTSDALE RD
Mailing Address - Street 2:STE 180
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85257-3411
Mailing Address - Country:US
Mailing Address - Phone:480-874-9800
Mailing Address - Fax:480-874-9804
Practice Address - Street 1:1375 N SCOTTSDALE RD
Practice Address - Street 2:STE 180
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85257-3411
Practice Address - Country:US
Practice Address - Phone:480-874-9800
Practice Address - Fax:480-874-9804
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-20
Last Update Date:2013-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAP2495OtherSTATE LICENCE