Provider Demographics
NPI:1710695473
Name:MOUNTAIN RIDGE HEALTHCARE PLLC
Entity Type:Organization
Organization Name:MOUNTAIN RIDGE HEALTHCARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN / BUSINESS OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:LLOYD
Authorized Official - Last Name:ROBERTS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:801-663-1296
Mailing Address - Street 1:174 S 600 E
Mailing Address - Street 2:
Mailing Address - City:ALPINE
Mailing Address - State:UT
Mailing Address - Zip Code:84004-1724
Mailing Address - Country:US
Mailing Address - Phone:801-663-1296
Mailing Address - Fax:
Practice Address - Street 1:2135 W MAIN ST STE B105
Practice Address - Street 2:
Practice Address - City:LEHI
Practice Address - State:UT
Practice Address - Zip Code:84043-6936
Practice Address - Country:US
Practice Address - Phone:801-663-1296
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-11
Last Update Date:2022-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty