NPIMap

Organization Active NPI

Mountain Medical Clinic PC

  • Internal Medicine Physician
  • Bland, VA
National Provider Identifier
1962498899
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
MOUNTAIN MEDICAL CLINIC PC
Practice address
144 Seddon St
Bland, VA 24315-5365
Phone
(276) 688-4800
Fax
(276) 688-4805
NPI assigned
Sep 26, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Mrs. Padmaja Pam Polavarapu, MDNPI 1376536862
Title
President
Phone
(276) 688-4800

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207R00000X Primary

Addresses

Primary practice location

144 Seddon St
Bland, VA 24315-5365

Mailing address

144 Seddon St
Bland, VA 24315-5365
Phone (276) 688-4800

National Provider Directory

National Provider Directory

Locations

144 Seddon St
Bland, VA 24315
Phone (276) 688-4800

Practitioners & affiliated clinicians

Practitioners 3

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

NPI Registry JSON

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

{
    "created_epoch": "1127692800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1962498899",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "144 SEDDON ST",
            "city": "BLAND",
            "state": "VA",
            "postal_code": "243155365",
            "telephone_number": "276-688-4800",
            "fax_number": "276-688-4805"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "144 SEDDON ST",
            "city": "BLAND",
            "state": "VA",
            "postal_code": "243155365",
            "telephone_number": "276-688-4800",
            "fax_number": "276-688-4805"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOUNTAIN MEDICAL CLINIC PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-09-26",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "POLAVARAPU",
        "authorized_official_first_name": "PADMAJA",
        "authorized_official_middle_name": "PAM",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "276-688-4800",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bland, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.