Provider Demographics
NPI:1255843462
Name:HIGH COUNTRY MEDICAL SUPPLY
Entity type:Organization
Organization Name:HIGH COUNTRY MEDICAL SUPPLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:BOONE
Authorized Official - Last Name:HODGES
Authorized Official - Suffix:
Authorized Official - Credentials:OTR
Authorized Official - Phone:307-887-2877
Mailing Address - Street 1:PO BOX 860
Mailing Address - Street 2:
Mailing Address - City:THAYNE
Mailing Address - State:WY
Mailing Address - Zip Code:83127-0860
Mailing Address - Country:US
Mailing Address - Phone:307-883-8877
Mailing Address - Fax:307-883-8876
Practice Address - Street 1:47 DOC PERKES RD
Practice Address - Street 2:
Practice Address - City:AFTON
Practice Address - State:WY
Practice Address - Zip Code:83110
Practice Address - Country:US
Practice Address - Phone:307-883-8877
Practice Address - Fax:307-883-8876
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-27
Last Update Date:2017-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies