Provider Demographics
NPI:1437451556
Name:MOUNTAIN CARE DME LLC
Entity Type:Organization
Organization Name:MOUNTAIN CARE DME LLC
Other - Org Name:MOUNTAIN CARE DME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:TONYA
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-506-5010
Mailing Address - Street 1:4426 CENTURY DR
Mailing Address - Street 2:SUITE G
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84123-2580
Mailing Address - Country:US
Mailing Address - Phone:801-506-5010
Mailing Address - Fax:801-747-3088
Practice Address - Street 1:4426 CENTURY DR
Practice Address - Street 2:SUITE G
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84123-2580
Practice Address - Country:US
Practice Address - Phone:801-506-5010
Practice Address - Fax:801-747-3088
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-22
Last Update Date:2011-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT332B00000X
UT7529823-1714332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies