Healthcare Provider Details

I. General information

NPI: 1184770307
Provider Name (Legal Business Name): MOUNTAIN MEDICAL SPECIALISTS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2007
Last Update Date: 10/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

595 RUSSELL ST
CRAIG CO
81625-1920
US

IV. Provider business mailing address

PO BOX 1435
CRAIG CO
81626-1435
US

V. Phone/Fax

Practice location:
  • Phone: 970-826-0911
  • Fax: 970-826-0910
Mailing address:
  • Phone: 970-826-0910
  • Fax: 970-826-0911

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 Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. PAMELA R KINDER
Title or Position: PRESIDENT OWNER
Credential: MD
Phone: 970-826-0910