Healthcare Provider Details

I. General information

NPI: 1609345685
Provider Name (Legal Business Name): MOUNTAIN VISTA MEDICAL CENTER, LP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/19/2018
Last Update Date: 08/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4545 N HUNT HWY
FLORENCE AZ
85132-6937
US

IV. Provider business mailing address

1301 S CRISMON RD
MESA AZ
85209-3767
US

V. Phone/Fax

Practice location:
  • Phone: 520-868-3333
  • Fax:
Mailing address:
  • Phone: 480-358-6100
  • Fax: 480-358-6168

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number
License Number State

VIII. Authorized Official

Name: JACOB GOLICH
Title or Position: HOSPITAL PRESIDENT
Credential:
Phone: 480-358-6100