MOUNTAIN MEDICAL SUPPLY, LLC (NPI# 1306362769) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1306362769 |
| Entity Type | Organization |
| Organization Name | MOUNTAIN MEDICAL SUPPLY, LLC |
| Practice Address |
6120 Woodside Executive Ct Aiken SC 29803-3820 |
| Mailing Address |
723 N 1890 W Ste 38a Provo UT 84601-1333 |
| Practice Telephone | 8036417417 |
| Practice Fax Number | 8774922716 |
| Mailing Telephone | 8774922704 |
| Mailing Fax Number | 8774922716 |
| Enumeration Date | 2017-08-17 |
| Last Update Date | 2020-05-27 |
| Authorized Official Name | WAYNE REAVES (CHIEF FINANCIAL OFFICER) |
| Authorized Official Telephone | 8774922704 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 332B00000X | Durable Medical Equipment & Medical Supplies | 170014 | KY | Suppliers |
| Y | 332B00000X | Durable Medical Equipment & Medical Supplies | 14834 | SC | Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| U.S. DEPT OF LABOR OFFICE OF WORKERS' COMPENSATION PROGRAMS | 617577000 | 01 | |
| U.S. DEPT OF LABOR OFFICE OF WORKERS' COMPENSATION PROGRAMS | 622826800 | 01 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 704 Jefferson St, Paducah, KY 420016818 | 8774922704 | 8774922716 |
| Street Address |
6120 WOODSIDE EXECUTIVE CT |
| City | AIKEN |
| State | SC |
| Zip Code | 29803-3820 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1871147454 | Augusta Oncology Associates, P.C. | Specialist | 222 University Parkway, Aiken, SC 29803 | 2019-07-31 |
| 1356804546 | Ebony Johnson | Home Health Aide | 942 C Dougherty Rd, Aiken, SC 29803 | 2019-04-13 |
| 1689144230 | Tabatha Lee Maddox | Occupational Therapist | 550 East Gate Dr, Aiken, SC 29803 | 2018-11-27 |
| 1962995100 | Pvd Internal Medicine Associates LLC | Internal Medicine | 440 Society Hill Dr Ste B, Aiken, SC 29803 | 2018-06-12 |
| 1689197691 | Trent David Yoder | Dentist | 174 Crepe Myrtle Drive, Aiken, SC 29803 | 2017-07-21 |
| 1770039331 | Lauren Reigot | Physical Therapist | 6140 Woodside Executive Ct., Aiken, SC 29803 | 2016-09-01 |
| 1851747190 | Umg Primary Care South Carolina, LLC | Family Medicine | 1023 Silver Bluff Road, Aiken, SC 29803 | 2016-05-05 |
| 1912375759 | Lisa G Browning | Nurse Practitioner | 550 E. Gate Drive, Aiken, SC 29803 | 2015-09-10 |
| 1346682754 | Tyresia Jovon White | Dentist | 440 Society Hill Dr Ste 201, Aiken, SC 29803 | 2013-07-25 |
| 1528327483 | Caresouth Hospice, LLC | Hospice Care, Community Based | 37 Varden Drive, Suite B, Aiken, SC 29803 | 2012-05-14 |
| Find all providers in zip 29803 | ||||
| Taxonomy Code | 332B00000X |
| Grouping | Suppliers |
| Classification | Durable Medical Equipment & Medical Supplies |
| A supplier of medical equipment such as respirators, wheelchairs, home dialysis systems, or monitoring systems, that are prescribed by a physician for a patient’s use in the home and that are usable for an extended period of time. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1912304197 | Advanced Medical Group, LLC | Durable Medical Equipment & Medical Supplies | 839 Richland Ave W, Aiken, SC 29801-3833 | 2014-12-03 |
| 1710310792 | Sams East Inc | Durable Medical Equipment & Medical Supplies | 220 Jefferson Davis Hwy, Aiken, SC 29801-2834 | 2013-08-14 |
| 1356674931 | Walgreen Co | Durable Medical Equipment & Medical Supplies | 3510 Richland Ave W, Aiken, SC 29801-6312 | 2009-09-14 |
| 1942443254 | Mjw Corporation | Durable Medical Equipment & Medical Supplies | 110 Price Ave, Aiken, SC 29803-7395 | 2009-04-16 |
| 1528229390 | Walgreen Co. | Durable Medical Equipment & Medical Supplies | 2191 Whiskey Rd, Aiken, SC 29803-6138 | 2008-06-24 |
| 1487854204 | Wal-mart Stores East Lp | Durable Medical Equipment & Medical Supplies | 3581 Richland Ave W, Aiken, SC 29801-6311 | 2007-07-19 |
| 1821117375 | Tlc Medical Centre, Inc. | Durable Medical Equipment & Medical Supplies | 190 Crepe Myrtle Dr, Aiken, SC 29803-7543 | 2007-03-28 |
| 1083713267 | Eckerd Corporation | Durable Medical Equipment & Medical Supplies | 943 Pine Log Road, Aiken, SC 29803-7330 | 2006-09-22 |
| 1831292374 | South Carolina Cvs Pharmacy LLC | Durable Medical Equipment & Medical Supplies | 1041 York St Ne, Aiken, SC 29801-4025 | 2006-09-07 |
| 1518060284 | South Carolina Cvs Pharmacy LLC | Durable Medical Equipment & Medical Supplies | 2062 Whiskey Rd, Aiken, SC 29803-6183 | 2006-09-07 |
| Find all providers in AIKEN | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.