Provider Demographics
NPI:1902003999
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:
Authorized Official - First Name:HEATH
Authorized Official - Middle Name:WEST
Authorized Official - Last Name:SUTTON
Authorized Official - Suffix:
Authorized Official - Credentials:RRT-RCP
Authorized Official - Phone:828-586-5353
Mailing Address - Street 1:1643 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SYLVA
Mailing Address - State:NC
Mailing Address - Zip Code:28779-5815
Mailing Address - Country:US
Mailing Address - Phone:828-586-5353
Mailing Address - Fax:828-586-2525
Practice Address - Street 1:1643 E MAIN ST
Practice Address - Street 2:
Practice Address - City:SYLVA
Practice Address - State:NC
Practice Address - Zip Code:28779-5815
Practice Address - Country:US
Practice Address - Phone:828-586-5353
Practice Address - Fax:828-586-2525
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-02
Last Update Date:2008-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7704740Medicaid
NC7704740Medicaid