Basic Information
| Provider Information | |||||||||
| NPI: | 1730423492 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | MOUNTAIN VIEW HOSPITAL LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | MOUNTAIN VIEW REDICARE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2325 CORONADO ST | ||||||||
| Address2: | |||||||||
| City: | IDAHO FALLS | ||||||||
| State: | ID | ||||||||
| PostalCode: | 834047407 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2085572700 | ||||||||
| FaxNumber: | 2085572701 | ||||||||
| Practice Location | |||||||||
| Address1: | 2730 CHANNING WAY | ||||||||
| Address2: | |||||||||
| City: | IDAHO FALLS | ||||||||
| State: | ID | ||||||||
| PostalCode: | 834045049 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2085427100 | ||||||||
| FaxNumber: | 2085427150 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/19/2012 | ||||||||
| LastUpdateDate: | 11/12/2013 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | HILLYARD | ||||||||
| AuthorizedOfficialFirstName: | NED | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CHEIF COMPLIANCE OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 2085572711 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | MOUNTAIN VIEW HOSPITAL LLC | ||||||||
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| AuthorizedOfficialCredential: | CCO | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332BC3200X | Y | Suppliers | Durable Medical Equipment & Medical Supplies | Customized Equipment |
No ID Information.