MOUNTAIN MEDICAL GROUP LLC NPI 1104962067

NPI Information

NPI: 1104962067
Provider Name: MOUNTAIN MEDICAL GROUP LLC
Classification: Clinic/Center - 261QU0200X
Entity Type: Organization

Specialization: Urgent Care

CLIA Number: 38D2267614

Address:
1302 NE 3RD ST
BEND, OR
ZIP 97701
Phone: (541) 388-7799
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MOUNTAIN MEDICAL GROUP LLC is an urgent care clinic center in Bend, OR. MOUNTAIN MEDICAL GROUP LLC NPI is 1104962067. The provider is registered as an organization entity type.

The provider's business location address is:

1302 NE 3RD ST
BEND, OR
ZIP 97701-333
Phone: (541) 388-7799
Fax: (541) 389-4096

The provider's authorized official is Albert James Stone .
The authorized official title is Owner and has the following contact phone number (541) 317-0909.

The CLIA number assigned to this NPI record is 38D2267614 - community clinic with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 1/29/2007 and was last updated on 12/4/2007.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QU0200X	Clinic/Center	Urgent Care			Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	R101956	MEDICARE PIN	OREGON

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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