Provider Demographics
NPI:1306920368
Name:CAROLINA MOUNTAIN MEDICAL SUPPLIES
Entity type:Organization
Organization Name:CAROLINA MOUNTAIN MEDICAL SUPPLIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:CAUBLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-628-8200
Mailing Address - Street 1:1356 CHARLOTTE HWY
Mailing Address - Street 2:
Mailing Address - City:FAIRVIEW
Mailing Address - State:NC
Mailing Address - Zip Code:28730-8798
Mailing Address - Country:US
Mailing Address - Phone:828-628-8200
Mailing Address - Fax:828-628-8240
Practice Address - Street 1:1356 CHARLOTTE HWY
Practice Address - Street 2:
Practice Address - City:FAIRVIEW
Practice Address - State:NC
Practice Address - Zip Code:28730-8798
Practice Address - Country:US
Practice Address - Phone:828-628-8200
Practice Address - Fax:828-628-8240
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC07-00019520332B00000X, 332BC3200X, 332BN1400X, 332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Not Answered332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Not Answered332BN1400XSuppliersDurable Medical Equipment & Medical SuppliesNursing Facility Supplies
Not Answered332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies