Provider Demographics
NPI:1134790462
Name:MOUNTAIN VIEW FAMILY MEDICINE LLC
Entity type:Organization
Organization Name:MOUNTAIN VIEW FAMILY MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:TOTTER
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:505-884-0079
Mailing Address - Street 1:703 CHARLES PL NW
Mailing Address - Street 2:
Mailing Address - City:LOS RANCHOS
Mailing Address - State:NM
Mailing Address - Zip Code:87107-6224
Mailing Address - Country:US
Mailing Address - Phone:505-297-7759
Mailing Address - Fax:
Practice Address - Street 1:4600 MONTGOMERY BLVD NE STE D201
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-1211
Practice Address - Country:US
Practice Address - Phone:505-610-1155
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-07
Last Update Date:2021-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM1932430501Medicaid