MEDICARE: MOUNTAIN VALLEY ORTHOPEDICS, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207X00000X	Orthopaedic Surgery Physician	2006-00132	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1418Y	OTHER	NC	BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1063476968
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOUNTAIN VALLEY ORTHOPEDICS, PLLC

Provider Business Mailing Address
First Line	:	145 MEDICAL PARK LN
Second Line	:	SUITE I
City	:	MURPHY
State	:	NC
Zip	:	28906-6850
Country	:	US
Telephone Number	:	828-837-3781
Fax Number	:	828-835-3486

Provider Business Practice Location Address
First Line	:	145 MEDICAL PARK LN
Second Line	:	SUITE I
City	:	MURPHY
State	:	NC
Zip	:	28906-6850
Country	:	US
Telephone Number	:	828-837-3781
Fax Number	:	828-835-3486

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	CARIE FREE
Credential	:
Telephone Number	:	828-837-9181

Provider Enumeration Date	:	04/17/2006
Last Update Date	:	05/14/2008

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