Healthcare Provider Details

I. General information

NPI: 1780897629
Provider Name (Legal Business Name): MOUNTAIN VIEW OBSTETRICS AND GYNECOLOGY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2007
Last Update Date: 12/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 UNDERCLIFF TER
PRINCETON WV
24740-2174
US

IV. Provider business mailing address

112 UNDERCLIFF TER
PRINCETON WV
24740-2174
US

V. Phone/Fax

Practice location:
  • Phone: 304-425-3800
  • Fax: 304-487-3914
Mailing address:
  • Phone: 304-425-3800
  • Fax: 304-487-3914

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number10054254
License Number StateWV

VIII. Authorized Official

Name: DR. JOE CAREY ELLINGTON JR.
Title or Position: MEMBER
Credential: PH.D., M.D.
Phone: 304-425-3800