Provider Demographics
NPI:1063229268
Name:MOUNTAIN OVER EARTH LLC
Entity type:Organization
Organization Name:MOUNTAIN OVER EARTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACUPUNCTURIST / OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAIME
Authorized Official - Middle Name:
Authorized Official - Last Name:FRITSCH
Authorized Official - Suffix:
Authorized Official - Credentials:DACM, LAC
Authorized Official - Phone:619-751-6904
Mailing Address - Street 1:857 MOUNTAIN RIVERS LN
Mailing Address - Street 2:
Mailing Address - City:MINERAL BLUFF
Mailing Address - State:GA
Mailing Address - Zip Code:30559-7922
Mailing Address - Country:US
Mailing Address - Phone:619-751-6904
Mailing Address - Fax:
Practice Address - Street 1:112 PROFESSIONAL RD STE 1
Practice Address - Street 2:
Practice Address - City:BLUE RIDGE
Practice Address - State:GA
Practice Address - Zip Code:30513-7350
Practice Address - Country:US
Practice Address - Phone:619-751-6904
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-12
Last Update Date:2024-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty