Provider Demographics
NPI:1770835472
Name:MOUNTAIN VIEW PATHOLOGY ASSOCIATES PLLC
Entity Type:Organization
Organization Name:MOUNTAIN VIEW PATHOLOGY ASSOCIATES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:BRENTON
Authorized Official - Middle Name:A
Authorized Official - Last Name:MEDA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:406-727-0484
Mailing Address - Street 1:2619 16TH AVE S
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59405-5202
Mailing Address - Country:US
Mailing Address - Phone:406-727-0484
Mailing Address - Fax:406-453-9504
Practice Address - Street 1:2619 16TH AVE S
Practice Address - Street 2:
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59405-5202
Practice Address - Country:US
Practice Address - Phone:406-727-0484
Practice Address - Fax:406-453-9504
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-05
Last Update Date:2012-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory