Provider Demographics
NPI:1811064157
Name:MOUNTAIN VIEW MEDICAL SERVICES
Entity type:Organization
Organization Name:MOUNTAIN VIEW MEDICAL SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:RUPE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:704-510-4366
Mailing Address - Street 1:3230 PROSPERITY CHURCH RD
Mailing Address - Street 2:STE 101
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28269
Mailing Address - Country:US
Mailing Address - Phone:704-965-7454
Mailing Address - Fax:704-510-4347
Practice Address - Street 1:3230 PROSPERITY CHURCH RD
Practice Address - Street 2:SUITE 101
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28269-8251
Practice Address - Country:US
Practice Address - Phone:704-510-4366
Practice Address - Fax:704-510-4347
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-30
Last Update Date:2007-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC36420313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
013UNOtherBCBS
NC89013UNMedicaid
NC89013UNMedicaid
2320377Medicare ID - Type Unspecified