MEDICARE: MOUNTAIN VISTA EMERGENCY PHYSICIANS, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	363A00000X	Physician Assistant
2	363L00000X	Nurse Practitioner
3	207P00000X	Emergency Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1164642963
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOUNTAIN VISTA EMERGENCY PHYSICIANS, LLC

Provider Business Mailing Address
First Line	:	200 CORPORATE BLVD
Second Line	:
City	:	LAFAYETTE
State	:	LA
Zip	:	70508-3870
Country	:	US
Telephone Number	:	800-893-9698
Fax Number	:

Provider Business Practice Location Address
First Line	:	5750 E BASELINE RD
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85206-4806
Country	:	US
Telephone Number	:	602-833-6900
Fax Number	:

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	LISHA C FALK
Credential	:
Telephone Number	:	337-609-1221

Provider Enumeration Date	:	04/26/2007
Last Update Date	:	01/06/2023

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