Provider Demographics
NPI:1023125986
Name:MOUNTAIN SPRINGS FAMILY PRACTICE LLC
Entity type:Organization
Organization Name:MOUNTAIN SPRINGS FAMILY PRACTICE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:FAMILY NURSE PRACTITIONER MEMBER
Authorized Official - Prefix:MS
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:BLACK
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:540-929-9095
Mailing Address - Street 1:9104 FLOYD HWY N
Mailing Address - Street 2:
Mailing Address - City:COPPER HILL
Mailing Address - State:VA
Mailing Address - Zip Code:24079-2114
Mailing Address - Country:US
Mailing Address - Phone:540-929-9095
Mailing Address - Fax:540-929-9003
Practice Address - Street 1:9104 FLOYD HWY N
Practice Address - Street 2:
Practice Address - City:COPPER HILL
Practice Address - State:VA
Practice Address - Zip Code:24079-2114
Practice Address - Country:US
Practice Address - Phone:540-929-9095
Practice Address - Fax:540-929-9003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Not Answered261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Single Specialty