Healthcare Provider Details

I. General information

NPI: 1144405200
Provider Name (Legal Business Name): MOUNTAIN VIEW MEDICAL GROUP, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2008
Last Update Date: 08/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5014 EL CAMINO DR
COLORADO SPRINGS CO
80918-2104
US

IV. Provider business mailing address

5575 TECH CENTER DR STE 106
COLORADO SPRINGS CO
80919-2353
US

V. Phone/Fax

Practice location:
  • Phone: 719-635-7700
  • Fax: 719-635-1794
Mailing address:
  • Phone: 719-590-1177
  • Fax: 719-590-1360

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: NICHOLAS SOL
Title or Position: PROVIDER
Credential: D.P.M.
Phone: 719-635-7700