MOUNTAIN MEDICAL PEDIATRICS NPI 1821210352

NPI Information

NPI: 1821210352
Provider Name: MOUNTAIN MEDICAL PEDIATRICS
Classification: Specialist - 174400000X
Entity Type: Organization

CLIA Number: 33D1022055

Address:
1927 SARANAC AVE
SARANAC LAKE, NY
ZIP 12983
Phone: (518) 523-7575
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MOUNTAIN MEDICAL PEDIATRICS is a specialist in Saranac Lake, NY. The provider is an individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. MOUNTAIN MEDICAL PEDIATRICS NPI is 1821210352. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

1927 SARANAC AVE
SARANAC LAKE, NY
ZIP 12983
Phone: (518) 523-7575

The provider's authorized official is Keri Wallace .
The authorized official title is M.d. and has the following contact phone number (518) 523-7575.

The CLIA number assigned to this NPI record is 33D1022055 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 5/3/2007 and was last updated on 2/18/2008.

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	174400000X	Specialist		236345	NEW YORK	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	BA0289	MEDICARE ID-TYPE UNSPECIFIED	NEW YORK
2	02752954	MEDICAID	NEW YORK

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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