Provider Demographics
NPI:1275547044
Name:MOUNTAIN MEDICAL SUPPLY INC
Entity type:Organization
Organization Name:MOUNTAIN MEDICAL SUPPLY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:CATHY
Authorized Official - Middle Name:M
Authorized Official - Last Name:ROMERO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-758-8081
Mailing Address - Street 1:1399 WEIMER RD
Mailing Address - Street 2:STE 700A
Mailing Address - City:TAOS
Mailing Address - State:NM
Mailing Address - Zip Code:87571-6355
Mailing Address - Country:US
Mailing Address - Phone:505-758-8081
Mailing Address - Fax:505-758-2903
Practice Address - Street 1:1399 WEIMER RD
Practice Address - Street 2:STE 700A
Practice Address - City:TAOS
Practice Address - State:NM
Practice Address - Zip Code:87571-6355
Practice Address - Country:US
Practice Address - Phone:505-758-8081
Practice Address - Fax:505-758-2903
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMT0080Medicaid
NMT548OtherBCBS
NM0344820001Medicare ID - Type Unspecified