Healthcare Provider Details

I. General information

NPI: 1285460147
Provider Name (Legal Business Name): MOUNTAIN VIEW MEDICAL CENTER PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2024
Last Update Date: 09/09/2024
Certification Date: 09/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

126 BLAKEMORE MILL RD
EWING VA
24248-8673
US

IV. Provider business mailing address

126 BLAKEMORE MILL RD
EWING VA
24248-8673
US

V. Phone/Fax

Practice location:
  • Phone: 276-240-0239
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CHANDA MCELYEA
Title or Position: OWNER, NP
Credential:
Phone: 276-240-0239