Basic Information
| Provider Information | |||||||||
| NPI: | 1376959569 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | MOUNTAIN VALLEY ORTHOPEDICS PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 100 COMMUNITY DRIVE SUITE 210 | ||||||||
| Address2: | |||||||||
| City: | TOBYHANNA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 18466 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5704217020 | ||||||||
| FaxNumber: | 5704217091 | ||||||||
| Practice Location | |||||||||
| Address1: | 100 COMMUNITY DRIVE STUITE 210 | ||||||||
| Address2: | |||||||||
| City: | TOBYHANNA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 18466 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5704217020 | ||||||||
| FaxNumber: | 5704217091 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/08/2014 | ||||||||
| LastUpdateDate: | 07/08/2014 | ||||||||
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| AuthorizedOfficialLastName: | LYNCH | ||||||||
| AuthorizedOfficialFirstName: | BONNIE | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PRACTICE ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 5704217020 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 333600000X | Y | Suppliers | Pharmacy |
No ID Information.