Organization
MOUNT TAYLOR MEDICAL SUPPLY, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MATTHEW J MUNSON (PRESIDENT)
(505) 285-6934
Entity
Organization
Contact information
Practice address
1023 E HIGH ST, GRANTS, NM 87020-2445
(505) 285-6934
(505) 285-5773
Mailing address
PO BOX 760, GRANTS, NM 87020-0760
(505) 285-6934
(505) 285-5773
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
02414449005
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
R3703
—
NM
Enumeration date
12/26/2006
Last updated
12/11/2020
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