MEDICARE: MOUNTAINEER HEALTHCARE, PLLC

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	261QR1300X	Rural Health Clinic/Center		WV

General Provider Information

NPI Number	:	1821145301
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOUNTAINEER HEALTHCARE, PLLC

Provider Business Mailing Address
First Line	:	PO BOX 67
Second Line	:	1500 TERRACE ST
City	:	HINTON
State	:	WV
Zip	:	25951-0067
Country	:	US
Telephone Number	:	304-466-2933
Fax Number	:	304-466-2932

Provider Business Practice Location Address
First Line	:	1500 TERRACE ST
Second Line	:
City	:	HINTON
State	:	WV
Zip	:	25951
Country	:	US
Telephone Number	:	304-466-2933
Fax Number	:	304-466-2932

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MS. RUBINA TASNEEM KHAN
Credential	:
Telephone Number	:	304-466-2933

Provider Enumeration Date	:	01/05/2007
Last Update Date	:	06/09/2026

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