MEDICARE: MOUNTAIN VISTA MEDICAL CENTER, LP

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	282N00000X	General Acute Care Hospital

General Provider Information

NPI Number	:	1467109488
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOUNTAIN VISTA MEDICAL CENTER, LP

Provider Business Mailing Address
First Line	:	5750 E BASELINE RD
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85206-4806
Country	:	US
Telephone Number	:	520-868-3333
Fax Number	:	520-509-2852

Provider Business Practice Location Address
First Line	:	5750 E BASELINE RD
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85206-4806
Country	:	US
Telephone Number	:	520-868-3333
Fax Number	:	520-509-2852

Authorized Official
Title or Position	:	PROVIDER ENROLLMENT
Name	:	KATHY ATKINSON
Credential	:
Telephone Number	:	770-331-7514

Provider Enumeration Date	:	03/09/2022
Last Update Date	:	03/09/2022

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