Provider Demographics
NPI:1093970832
Name:MOUNTAIN VIEW MEDICAL SUPPLY, INC.
Entity Type:Organization
Organization Name:MOUNTAIN VIEW MEDICAL SUPPLY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFERY
Authorized Official - Middle Name:J
Authorized Official - Last Name:SPARACIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-695-5161
Mailing Address - Street 1:PO BOX 821123
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98682
Mailing Address - Country:US
Mailing Address - Phone:360-695-5161
Mailing Address - Fax:360-695-2257
Practice Address - Street 1:7588 DELAWARE LANE
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98664
Practice Address - Country:US
Practice Address - Phone:360-695-5161
Practice Address - Fax:360-695-2257
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-22
Last Update Date:2010-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA602843542332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA6160480001Medicare NSC