1336226232 NPI number — MOUNTAINEER LOW AIR LOSS MATTRESS & MEDICAL EQUIPMENT INC.

Table of content: (NPI 1336226232)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336226232 NPI number — MOUNTAINEER LOW AIR LOSS MATTRESS & MEDICAL EQUIPMENT INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MOUNTAINEER LOW AIR LOSS MATTRESS & 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:
MEDCAREAMERICA
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:
1336226232
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
69 WALNUT ST
Provider Second Line Business Mailing Address:
SUITE A
Provider Business Mailing Address City Name:
SHINNSTON
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
26431-1139
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-592-5045
Provider Business Mailing Address Fax Number:
304-592-1963

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
69 WALNUT ST
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
SHINNSTON
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
26431-1139
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-592-5045
Provider Business Practice Location Address Fax Number:
304-592-1963
Provider Enumeration Date:
11/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LESHER
Authorized Official First Name:
REBECCA
Authorized Official Middle Name:
ANN
Authorized Official Title or Position:
VICE PRESIDENT
Authorized Official Telephone Number:
304-592-5045

Provider Taxonomy Codes

  • Taxonomy code: 332BC3200X , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 18003 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: ZRL141 . This is a "BC/BS MASS" identifier , issued by the state of ( MS ) . This identifiers is of the category "OTHER".
  • Identifier: 000000157551 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 575441 . This is a "ADVANTA FREEDOM" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: WV50700 . This is a "HEALTH PLAN UPPER OHIO VALLEY" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 0000000340852 . This is a "ANTHEM" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 3810001598 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0007260569 . This is a "AETNA" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 001705553 . This is a "BC/BS OF WEST VIRGINIA" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 1059205 . This is a "CAREPLUS HEALTH PLANS, INC." identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 001705553 . This is a "BLUE CROSS/ MOUNTAIN STATE" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".




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