Provider Demographics
NPI:1699814020
Name:MOUNTAIN MEDICAL PC, LLC
Entity Type:Organization
Organization Name:MOUNTAIN MEDICAL PC, LLC
Other - Org Name:MOUTAIN MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF MEDICAL SERVICES
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:LEVY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:304-530-8500
Mailing Address - Street 1:747 N MAIN ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:MOOREFIELD
Mailing Address - State:WV
Mailing Address - Zip Code:26836-1020
Mailing Address - Country:US
Mailing Address - Phone:304-530-8500
Mailing Address - Fax:304-530-8505
Practice Address - Street 1:747 N MAIN ST
Practice Address - Street 2:SUITE C
Practice Address - City:MOOREFIELD
Practice Address - State:WV
Practice Address - Zip Code:26836-1020
Practice Address - Country:US
Practice Address - Phone:304-530-8500
Practice Address - Fax:304-530-8505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-05
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care