Provider Demographics
NPI:1417060641
Name:MOUNTAINEER OXYGEN SERVICES
Entity Type:Organization
Organization Name:MOUNTAINEER OXYGEN SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:HEATH
Authorized Official - Middle Name:WEST
Authorized Official - Last Name:SUTTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-926-0208
Mailing Address - Street 1:42 BRANNER AVE
Mailing Address - Street 2:
Mailing Address - City:WAYNESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28786-3292
Mailing Address - Country:US
Mailing Address - Phone:828-926-0208
Mailing Address - Fax:828-926-0308
Practice Address - Street 1:42 BRANNER AVE
Practice Address - Street 2:
Practice Address - City:WAYNESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28786-3292
Practice Address - Country:US
Practice Address - Phone:828-926-0208
Practice Address - Fax:828-926-0308
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-15
Last Update Date:2010-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC02218332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7704440Medicaid
NCNCBDP01128OtherDME PERMIT
4977590001Medicare ID - Type Unspecified