| Organization Name: | MOUNTAINEER LOW AIR LOSS MATTRESS & MEDICAL EQUIPMENT INC. |
| NPI Number: | 1336226232 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | REBECCA ANN LESHER (VICE PRESIDENT) |
| Mailing Address: | 69 Walnut St Suite A Shinnston |
| State: | WV US |
| Postal Code: | 264311139 |
| Phone Number: | 3045925045 |
| Fax Number: | 3045921963 |
| NPI Enumeration Date: | 11/01/2006 |
| NPI Last Update Date: | 04/30/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 332BC3200X |
| License Number: | ========= |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WV |
| Taxonomy Type: | Suppliers |
| Taxonomy Classification: | Durable Medical Equipment & Medical Supplies |
| Taxonomy Specialization: | Customized Equipment |
| Taxonomy Definition: | |