Healthcare Provider Details

I. General information

NPI: 1336226232
Provider Name (Legal Business Name): MOUNTAINEER LOW AIR LOSS MATTRESS & MEDICAL EQUIPMENT INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

69 WALNUT ST SUITE A
SHINNSTON WV
26431-1139
US

IV. Provider business mailing address

69 WALNUT ST SUITE A
SHINNSTON WV
26431-1139
US

V. Phone/Fax

Practice location:
  • Phone: 304-592-5045
  • Fax: 304-592-1963
Mailing address:
  • Phone: 304-592-5045
  • Fax: 304-592-1963

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number StateWV

VIII. Authorized Official

Name: MISS REBECCA ANN LESHER
Title or Position: VICE PRESIDENT
Credential:
Phone: 304-592-5045