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General NPI Number Information
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NPI Number | 1073079273
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Entity Type | Organization
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Legal Business Name | MOUNTAIN FAMILY MEDICINE, LLC
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Dates
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Enumeration Date | 02/13/2019
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Last Update Date | 10/11/2021
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Provider Practice Location Address
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Address Line | 5425 N MAYO TRL STE 201
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City | PIKEVILLE
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State | KY
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Zip | 41501-2965
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Country | US
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Telephone | 606-432-0191
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Fax |
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Provider Business Mailing Address
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Address Line | 5425 N MAYO TRL STE 201
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City | PIKEVILLE
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State | KY
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Zip | 41501-2965
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Country | US
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Telephone | 606-432-0191
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Fax |
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Authorized Official
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Title or Position | OWNER/PHYSICIAN
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Name | DR. BRIAN DANIELS
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Credential | DO
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Telephone | 606-432-0191
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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