Organization
MOUNTAINEER HOME MEDICAL, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHELLE JACKSON (BILLING MANAGER)
(304) 225-6290
Entity
Organization
Contact information
Practice address
721 PARK ST, CUMBERLAND, MD 21502-3172
(240) 410-1170
(240) 362-7089
Mailing address
5000 GREENBAG RD STE F6, MORGANTOWN, WV 26501-7123
(304) 225-6290
(304) 225-1115
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
332BC3200X
Customized Equipment (DME)
—
—
332BX2000X
Oxygen Equipment & Supplies (DME)
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5362500002
MD MEDICARE PTAN
MD
05
—
814066900
—
MD
Enumeration date
11/10/2021
Last updated
05/01/2026
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