Provider Demographics
NPI:1336226232
Name:MOUNTAINEER LOW AIR LOSS MATTRESS & MEDICAL EQUIPMENT INC.
Entity Type:Organization
Organization Name:MOUNTAINEER LOW AIR LOSS MATTRESS & MEDICAL EQUIPMENT INC.
Other - Org Name:MEDCAREAMERICA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MISS
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:LESHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-592-5045
Mailing Address - Street 1:69 WALNUT ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:SHINNSTON
Mailing Address - State:WV
Mailing Address - Zip Code:26431-1139
Mailing Address - Country:US
Mailing Address - Phone:304-592-5045
Mailing Address - Fax:304-592-1963
Practice Address - Street 1:69 WALNUT ST
Practice Address - Street 2:SUITE A
Practice Address - City:SHINNSTON
Practice Address - State:WV
Practice Address - Zip Code:26431-1139
Practice Address - Country:US
Practice Address - Phone:304-592-5045
Practice Address - Fax:304-592-1963
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA18003Medicaid
MSZRL141OtherBC/BS MASS
OH000000157551Medicaid
WV575441OtherADVANTA FREEDOM
WVWV50700OtherHEALTH PLAN UPPER OHIO VALLEY
WV0000000340852OtherANTHEM
WV3810001598Medicaid
WV0007260569OtherAETNA
WV001705553OtherBC/BS OF WEST VIRGINIA
WV1059205OtherCAREPLUS HEALTH PLANS, INC.
WV001705553OtherBLUE CROSS/ MOUNTAIN STATE
WV=========-100OtherAMERICAN PROGRESSIVE
PA18003Medicaid