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General NPI Number Information
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NPI Number | 1770835472
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Entity Type | Organization
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Legal Business Name | MOUNTAIN VIEW PATHOLOGY ASSOCIATES PLLC
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Dates
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Enumeration Date | 10/05/2012
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Last Update Date | 10/05/2012
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Provider Practice Location Address
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Address Line | 2619 16TH AVE S
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City | GREAT FALLS
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State | MT
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Zip | 59405-5202
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Country | US
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Telephone | 406-727-0484
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Fax | 406-453-9504
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Provider Business Mailing Address
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Address Line | 2619 16TH AVE S
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City | GREAT FALLS
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State | MT
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Zip | 59405-5202
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Country | US
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Telephone | 406-727-0484
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Fax | 406-453-9504
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Authorized Official
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Title or Position | MEMBER
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Name | BRENTON A MEDA
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Credential | MD
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Telephone | 406-727-0484
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State |
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