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General NPI Number Information
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NPI Number | 1225087398
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Entity Type | Organization
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Legal Business Name | MOUNTAIN-HOME MEDICAL GROUP, PA
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Dates
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Enumeration Date | 05/08/2006
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Last Update Date | 04/14/2011
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Provider Practice Location Address
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Address Line | 353 EAST 8TH STREET
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City | MOUNTAIN HOME
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State | AR
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Zip | 72653
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Country | US
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Telephone | 870-425-3125
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Fax | 870-424-5059
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Provider Business Mailing Address
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Address Line | PO BOX 1836
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City | MOUNTAIN HOME
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State | AR
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Zip | 72654-1836
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Country | US
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Telephone | 870-425-3125
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Fax | 870-424-5059
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Authorized Official
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Title or Position | OWNER
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Name | MRS. MAXWELL G CHENEY
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Credential | MD
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Telephone | 870-425-3125
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | MC0049
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License Number State | AR
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | MC0049
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License Number State | AR
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