Basic Information
| Provider Information | |||||||||
| NPI: | 1275730749 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MOUNTAIN VIEW MEDICAL, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2122 W 1800 N PMB 413 | ||||||||
| Address2: | |||||||||
| City: | CLINTON | ||||||||
| State: | UT | ||||||||
| PostalCode: | 840157923 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8017748888 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2122 WEST 1800 NORTH PMB 413 | ||||||||
| Address2: | |||||||||
| City: | CLINTON | ||||||||
| State: | UT | ||||||||
| PostalCode: | 84015 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8017748888 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/28/2007 | ||||||||
| LastUpdateDate: | 07/30/2007 | ||||||||
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| AuthorizedOfficialLastName: | ASTLE | ||||||||
| AuthorizedOfficialFirstName: | NELSON | ||||||||
| AuthorizedOfficialMiddleName: | LAFARR | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8017748888 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D, | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 305S00000X | Y | Managed Care Organizations | Point of Service |
No ID Information.