Provider Demographics
NPI:1912862590
Name:MOUNTAINEER HOME MEDICAL, LLC
Entity type:Organization
Organization Name:MOUNTAINEER HOME MEDICAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COLLECTIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-225-6290
Mailing Address - Street 1:1411 HONAKER AVE
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:WV
Mailing Address - Zip Code:24740-3047
Mailing Address - Country:US
Mailing Address - Phone:888-240-1030
Mailing Address - Fax:304-225-1115
Practice Address - Street 1:1411 HONAKER AVE
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:WV
Practice Address - Zip Code:24740-3047
Practice Address - Country:US
Practice Address - Phone:888-240-1030
Practice Address - Fax:304-225-1115
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MOUNTAINEER HOME MEDICAL, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-12-17
Last Update Date:2025-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies