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General NPI Number Information
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NPI Number | 1336226232
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Entity Type | Organization
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Legal Business Name | MOUNTAINEER LOW AIR LOSS MATTRESS & MEDICAL EQUIPMENT INC.
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Dates
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Enumeration Date | 11/01/2006
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 69 WALNUT ST SUITE A
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City | SHINNSTON
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State | WV
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Zip | 26431-1139
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Country | US
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Telephone | 304-592-5045
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Fax | 304-592-1963
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Provider Business Mailing Address
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Address Line | 69 WALNUT ST SUITE A
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City | SHINNSTON
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State | WV
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Zip | 26431-1139
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Country | US
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Telephone | 304-592-5045
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Fax | 304-592-1963
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | MISS REBECCA ANN LESHER
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Credential |
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Telephone | 304-592-5045
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BC3200X
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Taxonomy Name | Customized Equipment (DME)
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License Number |
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License Number State | WV
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