Provider Demographics
NPI:1184775793
Name:MOUNTAIN MEDICAL
Entity type:Organization
Organization Name:MOUNTAIN MEDICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:RENEE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:LOHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-533-5534
Mailing Address - Street 1:122 E BROAD ST
Mailing Address - Street 2:SUITE 122-A
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22046-4501
Mailing Address - Country:US
Mailing Address - Phone:703-533-5534
Mailing Address - Fax:
Practice Address - Street 1:720 N MAIN ST
Practice Address - Street 2:
Practice Address - City:MOOREFIELD
Practice Address - State:WV
Practice Address - Zip Code:26836-1021
Practice Address - Country:US
Practice Address - Phone:703-533-5534
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care