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General NPI Number Information
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NPI Number | 1861608507
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Entity Type | Organization
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Legal Business Name | MOUNTAIN SURGICAL, PLC
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Dates
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Enumeration Date | 05/16/2007
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Last Update Date | 06/08/2009
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Provider Practice Location Address
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Address Line | 596 RADIO HILL RD
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City | MARION
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State | VA
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Zip | 24354-4224
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Country | US
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Telephone | 276-783-6200
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Fax | 888-890-5913
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Provider Business Mailing Address
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Address Line | 596 RADIO HILL RD
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City | MARION
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State | VA
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Zip | 24354-4224
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Country | US
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Telephone | 276-783-6200
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Fax | 888-890-5913
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. ROBERT AMPUDIA
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Credential | MD
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Telephone | 276-783-6200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 0101226304
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License Number State | VA
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