Healthcare Provider Details

I. General information

NPI: 1023125986
Provider Name (Legal Business Name): MOUNTAIN SPRINGS FAMILY PRACTICE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9104 FLOYD HWY N
COPPER HILL VA
24079-2114
US

IV. Provider business mailing address

9104 FLOYD HWY N
COPPER HILL VA
24079-2114
US

V. Phone/Fax

Practice location:
  • Phone: 540-929-9095
  • Fax: 540-929-9003
Mailing address:
  • Phone: 540-929-9095
  • Fax: 540-929-9003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: MS. JEAN MARIE BLACK
Title or Position: FAMILY NURSE PRACTITIONER MEMBER
Credential: FNP
Phone: 540-929-9095