Provider Demographics
NPI:1821145301
Name:MOUNTAINEER HEALTHCARE, PLLC
Entity Type:Organization
Organization Name:MOUNTAINEER HEALTHCARE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:RUBINA
Authorized Official - Middle Name:TASNEEM
Authorized Official - Last Name:KHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-466-2933
Mailing Address - Street 1:PO BOX 67
Mailing Address - Street 2:1500 TERRACE ST
Mailing Address - City:HINTON
Mailing Address - State:WV
Mailing Address - Zip Code:25951-0067
Mailing Address - Country:US
Mailing Address - Phone:304-466-2933
Mailing Address - Fax:304-466-2932
Practice Address - Street 1:1500 TERRACE ST
Practice Address - Street 2:
Practice Address - City:HINTON
Practice Address - State:WV
Practice Address - Zip Code:25951
Practice Address - Country:US
Practice Address - Phone:304-466-2933
Practice Address - Fax:304-466-2932
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-05
Last Update Date:2011-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVG11509Medicare UPIN
WV513912Medicare Oscar/Certification