Healthcare Provider Details

I. General information

NPI: 1851366777
Provider Name (Legal Business Name): MOUNTAIN VIEW CLINIC I LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2006
Last Update Date: 10/06/2020
Certification Date: 10/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1102 CRESTWOOD CIR
MENA AR
71953-5513
US

IV. Provider business mailing address

1102 CRESTWOOD CIR
MENA AR
71953-5513
US

V. Phone/Fax

Practice location:
  • Phone: 479-394-7301
  • Fax: 479-394-7160
Mailing address:
  • Phone: 479-394-7301
  • Fax: 479-394-7160

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name: DR. RICHARD MARK LOCHALA
Title or Position: OWNER
Credential: M.D.
Phone: 479-394-7301