Provider Demographics
NPI:1700852530
Name:MOUNTAIN VIEW FAMILY PRACTICE PA
Entity Type:Organization
Organization Name:MOUNTAIN VIEW FAMILY PRACTICE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CONNIE
Authorized Official - Middle Name:R
Authorized Official - Last Name:HANEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-269-4144
Mailing Address - Street 1:PO BOX 1096
Mailing Address - Street 2:19797 HWY 5
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:AR
Mailing Address - Zip Code:72560-1096
Mailing Address - Country:US
Mailing Address - Phone:870-269-4144
Mailing Address - Fax:870-269-5723
Practice Address - Street 1:19797 HWY 5
Practice Address - Street 2:
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:AR
Practice Address - Zip Code:72560-1096
Practice Address - Country:US
Practice Address - Phone:870-269-4144
Practice Address - Fax:870-269-5723
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-23
Last Update Date:2011-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR157236002Medicaid
AR5F333Medicare PIN