Provider Demographics
NPI:1437616455
Name:MOUNTAIN MEDICAL SUPPLIES, LLC
Entity Type:Organization
Organization Name:MOUNTAIN MEDICAL SUPPLIES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JANA
Authorized Official - Middle Name:LEIGH
Authorized Official - Last Name:MORIN-PERKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:913-894-1064
Mailing Address - Street 1:9008 W 77TH ST
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66204-2531
Mailing Address - Country:US
Mailing Address - Phone:816-678-3839
Mailing Address - Fax:833-663-6322
Practice Address - Street 1:11765 W 86TH TER
Practice Address - Street 2:
Practice Address - City:LENEXA
Practice Address - State:KS
Practice Address - Zip Code:66214-1534
Practice Address - Country:US
Practice Address - Phone:913-894-1064
Practice Address - Fax:833-663-6322
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-26
Last Update Date:2020-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS9297946OtherPRIVATE INSURANCE