Healthcare Provider Details

I. General information

NPI: 1306920368
Provider Name (Legal Business Name): CAROLINA MOUNTAIN MEDICAL SUPPLIES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1356 CHARLOTTE HWY
FAIRVIEW NC
28730-8798
US

IV. Provider business mailing address

1356 CHARLOTTE HWY
FAIRVIEW NC
28730-8798
US

V. Phone/Fax

Practice location:
  • Phone: 828-628-8200
  • Fax: 828-628-8240
Mailing address:
  • Phone: 828-628-8200
  • Fax: 828-628-8240

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number07-00019520
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number07-00019520
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code332BN1400X
TaxonomyNursing Facility Supplies (DME)
License Number07-00019520
License Number StateNC
# 4
Primary TaxonomyY
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number07-00019520
License Number StateNC

VIII. Authorized Official

Name: MR. TERRY LEE CAUBLE
Title or Position: OWNER
Credential:
Phone: 828-628-8200