Healthcare Provider Details

I. General information

NPI: 1922332956
Provider Name (Legal Business Name): MOUNTAIN AIR, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2009
Last Update Date: 03/09/2023
Certification Date: 03/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1260 DOCTORS LANE
FORT COLLINS CO
80524
US

IV. Provider business mailing address

1260 DOCTORS LANE
FORT COLLINS CO
80524
US

V. Phone/Fax

Practice location:
  • Phone: 970-484-6407
  • Fax: 970-484-1269
Mailing address:
  • Phone: 970-484-6407
  • Fax: 970-484-1269

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier72129743
Identifier TypeMEDICAID
Identifier StateCO
Identifier Issuer

VIII. Authorized Official

Name: MRS. LINDA M DOLLAR
Title or Position: CEO
Credential:
Phone: 970-484-6407