Provider Demographics
NPI:1962935346
Name:MOUNTAIN MEDICAL LLC
Entity type:Organization
Organization Name:MOUNTAIN MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:D
Authorized Official - Last Name:WELLS
Authorized Official - Suffix:
Authorized Official - Credentials:ATP
Authorized Official - Phone:802-527-2959
Mailing Address - Street 1:39 BAY VIEW DR
Mailing Address - Street 2:
Mailing Address - City:SAINT ALBANS
Mailing Address - State:VT
Mailing Address - Zip Code:05478-5151
Mailing Address - Country:US
Mailing Address - Phone:802-527-2959
Mailing Address - Fax:
Practice Address - Street 1:39 BAY VIEW DR
Practice Address - Street 2:
Practice Address - City:SAINT ALBANS
Practice Address - State:VT
Practice Address - Zip Code:05478-5151
Practice Address - Country:US
Practice Address - Phone:802-527-2959
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-04
Last Update Date:2017-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies