Healthcare Provider Details

I. General information

NPI: 1528070216
Provider Name (Legal Business Name): MOUNTAINVIEW PEDIATRICS, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2006
Last Update Date: 05/22/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1204 N MAIN ST
MARION VA
24354-4312
US

IV. Provider business mailing address

1204 N MAIN ST
MARION VA
24354-4312
US

V. Phone/Fax

Practice location:
  • Phone: 276-783-2511
  • Fax: 276-783-2532
Mailing address:
  • Phone: 276-783-2511
  • Fax: 276-783-2532

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0101231927
License Number StateVA

VIII. Authorized Official

Name: MRS. GINGER TESTERMAN SHEETS
Title or Position: PRACTICE MANAGER
Credential:
Phone: 276-783-2511