Healthcare Provider Details

I. General information

NPI: 1225746423
Provider Name (Legal Business Name): MOUNTAIN PASS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2022
Last Update Date: 11/07/2022
Certification Date: 11/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

859 ALDERSON ST
WILLIAMSON WV
25661-3215
US

IV. Provider business mailing address

1602 AVENUE Q
LUBBOCK TX
79401-4732
US

V. Phone/Fax

Practice location:
  • Phone: 304-235-2500
  • Fax:
Mailing address:
  • Phone: 806-729-3445
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number
License Number State

VIII. Authorized Official

Name: HARRY KYLE SHEETS
Title or Position: OWNER
Credential: MD
Phone: 806-729-3445