MEDICARE: CAROLINA MOUNTAIN MEDICAL SUPPLIES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies	07-00019520	NC
2	332BC3200X	Customized Equipment (DME)	07-00019520	NC
3	332BN1400X	Nursing Facility Supplies (DME)	07-00019520	NC
4	332BX2000X	Oxygen Equipment & Supplies (DME)	07-00019520	NC

General Provider Information

NPI Number	:	1306920368
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAROLINA MOUNTAIN MEDICAL SUPPLIES

Provider Business Mailing Address
First Line	:	1356 CHARLOTTE HWY
Second Line	:
City	:	FAIRVIEW
State	:	NC
Zip	:	28730-8798
Country	:	US
Telephone Number	:	828-628-8200
Fax Number	:	828-628-8240

Provider Business Practice Location Address
First Line	:	1356 CHARLOTTE HWY
Second Line	:
City	:	FAIRVIEW
State	:	NC
Zip	:	28730-8798
Country	:	US
Telephone Number	:	828-628-8200
Fax Number	:	828-628-8240

Authorized Official
Title or Position	:	OWNER
Name	:	MR. TERRY LEE CAUBLE
Credential	:
Telephone Number	:	828-628-8200

Provider Enumeration Date	:	10/25/2006
Last Update Date	:	09/11/2025

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