Healthcare Provider Details

I. General information

NPI: 1902003999
Provider Name (Legal Business Name): MOUNTAINEER OXYGEN SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2007
Last Update Date: 08/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1643 E MAIN ST
SYLVA NC
28779-5815
US

IV. Provider business mailing address

1643 E MAIN ST
SYLVA NC
28779-5815
US

V. Phone/Fax

Practice location:
  • Phone: 828-586-5353
  • Fax: 828-586-2525
Mailing address:
  • Phone: 828-586-5353
  • Fax: 828-586-2525

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
Identifier7704740
Identifier TypeMEDICAID
Identifier StateNC
Identifier Issuer

VIII. Authorized Official

Name: HEATH WEST SUTTON
Title or Position: PRESIDENT
Credential: RRT-RCP
Phone: 828-586-5353