Basic Information
| Provider Information | |||||||||
| NPI: | 1619931524 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MOUNTAIN VIEW OB-GYN, LTD. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 20 NORTH ST | ||||||||
| Address2: | |||||||||
| City: | HANOVER | ||||||||
| State: | PA | ||||||||
| PostalCode: | 173312275 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7176377755 | ||||||||
| FaxNumber: | 7176377142 | ||||||||
| Practice Location | |||||||||
| Address1: | 20 NORTH ST | ||||||||
| Address2: | |||||||||
| City: | HANOVER | ||||||||
| State: | PA | ||||||||
| PostalCode: | 173312275 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7176377755 | ||||||||
| FaxNumber: | 7176377142 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/17/2006 | ||||||||
| LastUpdateDate: | 11/19/2015 | ||||||||
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| AuthorizedOfficialLastName: | NAYMICK | ||||||||
| AuthorizedOfficialFirstName: | STEPHEN | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7176377755 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | D.O. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 02432300 | 01 | PA | CAP BLUE CROSS | OTHER | 525999 | 01 | PA | PA BLUE SHIELD | OTHER |