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General NPI Number Information
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NPI Number | 1912862590
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Entity Type | Organization
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Legal Business Name | MOUNTAINEER HOME MEDICAL, LLC
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Dates
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Enumeration Date | 12/17/2025
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Last Update Date | 12/17/2025
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Provider Practice Location Address
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Address Line | 1411 HONAKER AVE
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City | PRINCETON
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State | WV
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Zip | 24740-3047
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Country | US
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Telephone | 888-240-1030
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Fax | 304-225-1115
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Provider Business Mailing Address
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Address Line | 1411 HONAKER AVE
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City | PRINCETON
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State | WV
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Zip | 24740-3047
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Country | US
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Telephone | 888-240-1030
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Fax | 304-225-1115
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Authorized Official
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Title or Position | COLLECTIONS MANAGER
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Name | MICHELLE JACKSON
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Credential |
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Telephone | 304-225-6290
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BX2000X
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Taxonomy Name | Oxygen Equipment & Supplies (DME)
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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