Mountain Psychiatric, LLC

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

Legal business name

MOUNTAIN PSYCHIATRIC, LLC

Practice address

5115 Bernard Dr
Suite 105
Roanoke, VA 24018-4357

Phone

(540) 728-1570

NPI assigned

Mar 13, 2014

Organization subpart

No

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Jason Charles Grove, DO

  • Psychiatry Physician
  • Roanoke, VA
  • NPI 1982801288

  Psychiatry, VA

  Medicare reassignment NPD

Medicare fee-for-service enrollment

Enrolled in VA

Enrollment records 1

Locations

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ms. Jennifer Colorado

Title

Credentialing

Phone

(832) 494-6448

Specialties & licenses 1

Addresses

The complete record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1394668800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1395187200000",
    "number": "1720404841",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5115 BERNARD DR",
            "address_2": "SUITE 105",
            "city": "ROANOKE",
            "state": "VA",
            "postal_code": "240184357",
            "telephone_number": "540-728-1570"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5115 BERNARD DR",
            "address_2": "SUITE 105",
            "city": "ROANOKE",
            "state": "VA",
            "postal_code": "240184357",
            "telephone_number": "540-728-1570"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOUNTAIN PSYCHIATRIC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-03-13",
        "last_updated": "2014-03-19",
        "status": "A",
        "authorized_official_last_name": "COLORADO",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_title_or_position": "CREDENTIALING",
        "authorized_official_telephone_number": "832-494-6448",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lorin Bonham Moseley
• Joseph Tuvia Moskal, M.D.
• Manyan Moss, PHARMD
• Yasaman Mossadad, DO
• Lisa M Moulse, DPT
• Mountain RX LLC
• Mountain Waves ABA, LLC
• Robert B Mountcastle, M.D.
• Tracy Mowles, LPC
• Jessica Blair Mowry, D.O.

• All providers in Roanoke, VA
• Psychiatry Physician in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 19, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.