Organization
MOUNTAIN MEDICAL SUPPLY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WAYNE REAVES (CHIEF FINANCIAL OFFICER)
(435) 327-0227
Entity
Organization
Contact information
Practice address
6170 WOODSIDE EXECUTIVE CT, AIKEN, SC 29803-3820
(435) 327-0227
(877) 492-2716
Mailing address
723 N 1890 W STE 38A, PROVO, UT 84601-1333
(435) 327-0227
(877) 492-2716
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
14834
SC
332B00000X
Durable Medical Equipment & Medical Supplies
170014
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
617577000
U.S. DEPT OF LABOR OFFICE OF WORKERS' COMPENSATION PROGRAMS
—
01
—
622826800
U.S. DEPT OF LABOR OFFICE OF WORKERS' COMPENSATION PROGRAMS
—
Enumeration date
08/17/2017
Last updated
09/08/2022
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