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General NPI Number Information
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NPI Number | 1811211048
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Entity Type | Organization
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Legal Business Name | MOUNTAIN ROSE FAMILY MEDICINE INC
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Dates
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Enumeration Date | 03/17/2010
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Last Update Date | 03/17/2010
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Provider Practice Location Address
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Address Line | ROUTE 4 BOX 104
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City | KEYSER
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State | WV
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Zip | 26726
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Country | US
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Telephone | 304-597-2490
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Fax | 304-597-2492
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Provider Business Mailing Address
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Address Line | RT 4 BOX 104
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City | KEYSER
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State | WV
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Zip | 26726
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Country | US
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Telephone | 304-597-2490
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Fax | 304-597-2492
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Authorized Official
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Title or Position | PHYSICIAN/OWNER
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Name | DR. ELAINE S PRICE
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Credential | DO
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Telephone | 304-597-2490
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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 | 02095
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License Number State | WV
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