Organization Name: | MOUNTAIN VALLEY RX 05 INC |
NPI Number: | 1043364490 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | BEAU KISABETH (MANAGER) |
Mailing Address: | 153 E Broadway Blvd Ste 103 Jefferson City |
State: | TN US |
Postal Code: | 377602517 |
Phone Number: | 8654715111 |
Fax Number: | 8654715199 |
NPI Enumeration Date: | 01/23/2007 |
NPI Last Update Date: | 03/30/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 332B00000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | |
Taxonomy Type: | Suppliers |
Taxonomy Classification: | Durable Medical Equipment & Medical Supplies |
Taxonomy Specialization: | |
Taxonomy Definition: | A supplier of medical equipment such as respirators, wheelchairs, home dialysis systems, or monitoring systems, that are prescribed by a physician for a patient |