# MOUNTAIN SPINE AND ACCIDENT CENTER LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Mountain Medical Center
- **Organization subpart:** No

## Provider details

- **NPI number:** 1417992264
- **Authorized official:** DR. MATTHEW THOMAS MOUNTAIN DC (CLINIC DIRECTOR)
- **Authorized official phone:** (386) 575-2225

## Contact information

- **Practice address:** 777 DELTONA BLVD, SUITE 21, DELTONA, FL 32725-7173
- **Practice address phone:** (386) 575-2225
- **Practice address fax:** (386) 575-1096
- **Mailing address:** 777 DELTONA BLVD, SUITE 21, DELTONA, FL 32725-7173
- **Mailing address phone:** (386) 575-2225
- **Mailing address fax:** (386) 575-1096

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM1300X | Multi-Specialty Clinic/Center | CH 8010 | FL | Yes |

## Other

- **Enumeration date:** 06/17/2006
- **Last updated:** 11/21/2008