NPIMap

Organization Active NPI

Mountaineer Home Medical, LLC

  • Durable Medical Equipment & Medical Supplies
  • Princeton, WV
National Provider Identifier
1912862590
Registry record updated Dec 17, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X
Legal business name
MOUNTAINEER HOME MEDICAL, LLC
Practice address
1411 Honaker Ave
Princeton, WV 24740-3047
Phone
(888) 240-1030
Fax
(304) 225-1115
NPI assigned
Dec 17, 2025
Organization subpart
Yes
Parent organization
MOUNTAINEER HOME MEDICAL, LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Dec 17, 2025

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

Authorized official

Name
Michelle Jackson
Title
Collections Manager
Phone
(304) 225-6290

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X Primary
Oxygen Equipment & Supplies (DME) 332BX2000X

Addresses

Primary practice location

1411 Honaker Ave
Princeton, WV 24740-3047

Mailing address

1411 Honaker Ave
Princeton, WV 24740-3047
Phone (888) 240-1030

National Provider Directory

National Provider Directory
Tax ID family
Mountaineer Home Medical LLC5 organizations share this tax ID, including this one
Part of
Mountaineer Home Medical LLC

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1765929600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1765929600000",
    "number": "1912862590",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1411 HONAKER AVE",
            "city": "PRINCETON",
            "state": "WV",
            "postal_code": "247403047",
            "telephone_number": "888-240-1030",
            "fax_number": "304-225-1115"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1411 HONAKER AVE",
            "city": "PRINCETON",
            "state": "WV",
            "postal_code": "247403047",
            "telephone_number": "888-240-1030",
            "fax_number": "304-225-1115"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOUNTAINEER HOME MEDICAL, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MOUNTAINEER HOME MEDICAL, LLC",
        "enumeration_date": "2025-12-17",
        "last_updated": "2025-12-17",
        "certification_date": "2025-12-17",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "MICHELLE",
        "authorized_official_title_or_position": "COLLECTIONS MANAGER",
        "authorized_official_telephone_number": "304-225-6290"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "332BX2000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Oxygen Equipment & Supplies",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Princeton, WV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 17, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.