Provider Demographics
NPI:1811076367
Name:MOUNTAIN VIEW MEDICAL SUPPLIES
Entity type:Organization
Organization Name:MOUNTAIN VIEW MEDICAL SUPPLIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:BARRY
Authorized Official - Last Name:PIVO
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:435-615-1073
Mailing Address - Street 1:PO BOX 680518
Mailing Address - Street 2:
Mailing Address - City:PARK CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84068-0518
Mailing Address - Country:US
Mailing Address - Phone:435-615-1073
Mailing Address - Fax:435-615-1074
Practice Address - Street 1:1890 BONANZA DR
Practice Address - Street 2:111
Practice Address - City:PARK CITY
Practice Address - State:UT
Practice Address - Zip Code:84060
Practice Address - Country:US
Practice Address - Phone:435-615-1073
Practice Address - Fax:435-615-1074
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT5736570001Medicare ID - Type Unspecified