Provider Demographics
NPI:1912200973
Name:MOUNTAIN VIEW FAMILY MEDICINE, LLC
Entity Type:Organization
Organization Name:MOUNTAIN VIEW FAMILY MEDICINE, LLC
Other - Org Name:MOUNTAIN VIEW FAMILY MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR FINANCE & ACCOUNTING
Authorized Official - Prefix:
Authorized Official - First Name:BETSY
Authorized Official - Middle Name:
Authorized Official - Last Name:PEARSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-675-4562
Mailing Address - Street 1:398 THE PKWY
Mailing Address - Street 2:
Mailing Address - City:GREER
Mailing Address - State:SC
Mailing Address - Zip Code:29650-4569
Mailing Address - Country:US
Mailing Address - Phone:864-877-9577
Mailing Address - Fax:864-877-9073
Practice Address - Street 1:398 THE PKWY
Practice Address - Street 2:
Practice Address - City:GREER
Practice Address - State:SC
Practice Address - Zip Code:29650-4569
Practice Address - Country:US
Practice Address - Phone:864-877-9577
Practice Address - Fax:864-877-9073
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-14
Last Update Date:2010-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP2794Medicaid