Mountain Medical Supply, LLC

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

License

14834 Issued in SC

Legal business name

MOUNTAIN MEDICAL SUPPLY, LLC

Practice address

6170 Woodside Executive CT
Aiken, SC 29803-3820

Phone

(435) 327-0227

Fax

(877) 492-2716

NPI assigned

Aug 17, 2017

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Wayne Reaves

Title

Chief Financial Officer

Phone

(435) 327-0227

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in SC

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1502928000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1662595200000",
    "number": "1306362769",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "723 N 1890 W STE 38A",
            "city": "PROVO",
            "state": "UT",
            "postal_code": "846011333",
            "telephone_number": "435-327-0227",
            "fax_number": "877-492-2716"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6170 WOODSIDE EXECUTIVE CT",
            "city": "AIKEN",
            "state": "SC",
            "postal_code": "298033820",
            "telephone_number": "435-327-0227",
            "fax_number": "877-492-2716"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "711 Jefferson St",
            "address_purpose": "LOCATION",
            "city": "Paducah",
            "state": "KY",
            "postal_code": "420016817",
            "country_code": "US",
            "telephone_number": "435-327-0227",
            "fax_number": "877-492-2716",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "MOUNTAIN MEDICAL SUPPLY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-08-17",
        "last_updated": "2022-09-08",
        "certification_date": "2022-09-08",
        "status": "A",
        "authorized_official_last_name": "REAVES",
        "authorized_official_first_name": "WAYNE",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "435-327-0227"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "SC",
            "license": "14834",
            "primary": true
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "KY",
            "license": "170014",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "U.S. DEPT OF LABOR OFFICE OF WORKERS' COMPENSATION PROGRAMS",
            "identifier": "617577000",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "U.S. DEPT OF LABOR OFFICE OF WORKERS' COMPENSATION PROGRAMS",
            "identifier": "622826800",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Caleb Benjamin Moss, DPT
• Danielle Motley-Jennings, D.C
• Deealice Moton, LMT
• Sopio Motsonelidze
• Cynthia Foster Motycka, LPC
• Leopoldo M Muniz, M.D.
• Timber Wages Munoz, PA-C
• Jackson Ryan Murphy, PHARM.D
• Susan Murphy
• Aarial Raschel Murray

• Durable Medical Equipment & Medical Supplies in Aiken, SC
• Providers in Aiken, SC by specialty
• Durable Medical Equipment & Medical Supplies in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 8, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.