1174523203 NPI number — MOUNTAIN MEDICAL EQUIPMENT, INC

Table of content: (NPI 1174523203)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174523203 NPI number — MOUNTAIN MEDICAL EQUIPMENT, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MOUNTAIN MEDICAL EQUIPMENT, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
NEB DOCTORS OF KY
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1174523203
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/06/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 922189
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORCROSS
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30010-2189
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-396-4994
Provider Business Mailing Address Fax Number:
888-835-3354

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1025 DOVE RUN RD STE 309
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEXINGTON
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40502-3588
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
779-364-4994
Provider Business Practice Location Address Fax Number:
888-835-3354
Provider Enumeration Date:
07/29/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
KAY
Authorized Official First Name:
SUE
Authorized Official Middle Name:
Authorized Official Title or Position:
SENIOR VICE PRESIDENT
Authorized Official Telephone Number:
888-588-9630

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 332BC3200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 90005505 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".