Provider Demographics
NPI:1932156437
Name:MOUNTAIN VIEW FAMILY MEDICINE PC
Entity Type:Organization
Organization Name:MOUNTAIN VIEW FAMILY MEDICINE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:FRAYSER
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:D O
Authorized Official - Phone:928-474-2888
Mailing Address - Street 1:122 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PAYSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85541-5646
Mailing Address - Country:US
Mailing Address - Phone:928-474-2888
Mailing Address - Fax:928-474-2992
Practice Address - Street 1:122 E MAIN ST
Practice Address - Street 2:
Practice Address - City:PAYSON
Practice Address - State:AZ
Practice Address - Zip Code:85541-5646
Practice Address - Country:US
Practice Address - Phone:928-474-2888
Practice Address - Fax:928-474-2992
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-28
Last Update Date:2008-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3727207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1Z4223OtherHEALTHNET
AZ793217Medicaid
AZ5452719OtherCOMMUNITY CARE NETWORK
AZ5455722OtherCOMMUNITY CARE NETWORK
AZ7428465OtherAETNA
AZAZ0734330OtherBCBS OF ARIZONA
AZ2110081OtherFIRST HEALTH
AZ21233109113OtherBEECHSTREET
AZ21233109178OtherBEECHSTREET
AZ788945Medicaid
AZP00024147OtherRAILROAD MEDICARE
AZ1Z9946OtherHEALTHNET
AZ2110075OtherFIRST HEALTH
AZ5280193OtherAETNA
AZAZ0734720OtherBCBS OF ARIZONA
AZP00024145OtherRAILROAD MEDICARE
AZP00024145OtherRAILROAD MEDICARE
AZ2110075OtherFIRST HEALTH
AZZ74778Medicare ID - Type Unspecified