Healthcare Provider Details

I. General information

NPI: 1114914678
Provider Name (Legal Business Name): MOUNTAIN MEDICAL SUPPLY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

521 MAIN ST
HAYSI VA
24256
US

IV. Provider business mailing address

PO BOX 279
HAYSI VA
24256
US

V. Phone/Fax

Practice location:
  • Phone: 276-865-4096
  • Fax: 276-865-4098
Mailing address:
  • Phone: 276-865-4096
  • Fax: 276-865-4098

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number0206009028
License Number StateVA

VIII. Authorized Official

Name: MRS. RHONDA LYNN SCANLON
Title or Position: MANAGER
Credential:
Phone: 276-865-4096