MOUNTAIN STATE PROSTHETICS, LLC (NPI# 1639124423) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1639124423 |
| Entity Type | Organization |
| Organization Name | MOUNTAIN STATE PROSTHETICS, LLC |
| Other Organization Name | MOUNTAIN STATE PROSTHETICS, LLC |
| Practice Address |
216 Brooks St Suite 100 Charleston WV 25301-1828 |
| Practice Telephone | 3043445593 |
| Practice Fax Number | 3043445595 |
| Mailing Telephone | 3043445593 |
| Mailing Fax Number | 3043445595 |
| Enumeration Date | 2006-05-23 |
| Last Update Date | 2012-03-15 |
| Authorized Official Name | DAVID P. HANSFORD (MANAGER) |
| Authorized Official Telephone | 3043445593 |
| Authorized Official Credential | CPO |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 335E00000X | Prosthetic/Orthotic Supplier | Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WV | 0147696000 | 05 |
| Other Name | Type Code |
|---|---|
| Mountain State Prosthetics, LLC | Other Name - Individual/Organization |
| Street Address |
216 BROOKS ST SUITE 100 |
| City | CHARLESTON |
| State | WV |
| Zip Code | 25301-1828 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1710314315 | Charleston Hearing Care, LLC | Audiologist | 216 Brooks St, Suite 301, Charleston, WV 25301-1828 | 2013-09-27 |
| 1275629271 | Janet D Lauerman | Audiologist | 216 Brooks St, Suite 301, Charleston, WV 25301-1828 | 2006-10-05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1669087680 | Kerrie Rena Harris | Counselor | 16 Leon Sullivan Way Suite 300, Charleston, WV 25301 | 2020-09-15 |
| 1285123471 | Burgess Dental | Dentist | 405 Capitol Street, The Parlor Suite, Charleston, WV 25301 | 2018-05-03 |
| 1104322320 | Kara Caldwell | Psychologist | 333 Laidley St., 4'th Floor East, Charleston, WV 25301 | 2018-04-05 |
| 1740638022 | Christina Phalen | Pharmacy Technician | 701 Lee Street East, Charleston, WV 25301 | 2016-05-27 |
| 1366867079 | Brooke Powell Garnes | Speech-Language Pathologist | 1313 Quarrier Street, Suite A, Charleston, WV 25301 | 2014-03-04 |
| 1952648404 | Implanted Pump Management, LLC | Home Infusion | 311 Laidley St., Suite 202, Charleston, WV 25301 | 2013-01-03 |
| 1730435108 | Chaitanya Mishra | Internal Medicine | 501 Morris St Ste 357, Charleston, WV 25301 | 2012-08-03 |
| 1033477278 | James Stephen Harman | Neurological Surgery | 415 Morris St Ste 400, Charleston, WV 25301 | 2012-04-25 |
| 1265674329 | Howard and Howard Dental LLC | Dentist | 1321 Virginia St., Charleston, WV 25301 | 2009-04-03 |
| 1881856144 | Steven David Hollosi | Emergency Medicine | 501 Morris St., Charleston, WV 25301 | 2008-06-27 |
| Find all providers in zip 25301 | ||||
| Taxonomy Code | 335E00000X |
| Grouping | Suppliers |
| Classification | Prosthetic/Orthotic Supplier |
| An organization that provides prosthetic and orthotic care which may include, but is not limited to, patient evaluation, prosthesis or orthosis design, fabrication, fitting and modification to treat limb loss for purposes of restoring physiological function and/or cosmesis or to treat a neuromusculoskeletal disorder or acquired condition. |
| Notes: Source: American Board for Certification in Orthotics, Prosthetics, and Pedorthics, Inc. [7/1/2010: modified, 7/1/2013: modified] Additional Resources: American Board for Certification in Orthotics, Prosthetics and Pedorthics, Inc., www.abcop.org and Board of Certification/Accreditation, International, www.bocusa.org. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1689209660 | Annedie Beauty Equipment Wholesale | Prosthetic/Orthotic Supplier | 3406 Pennsylvania Avenue, Charleston, WV 25302 | 2020-03-10 |
| 1306350426 | Musc Prosthetic Orthotic Services LLC | Prosthetic/Orthotic Supplier | 135 Rutledge Ave Fl 4, Charleston, SC 29425-8903 | 2017-11-28 |
| 1669893624 | Carolina Orthotics and Prosthetics LLC | Prosthetic/Orthotic Supplier | 1331 Ashley River Rd Bldg C, Charleston, SC 29407-5315 | 2013-12-18 |
| 1174848485 | Mcgrew Orthopedic, LLC | Prosthetic/Orthotic Supplier | 1301 Washington Street W, Charleston, WV 25302-1909 | 2010-03-30 |
| 1972747855 | Carolina Orthotics and Prosthetics of Myrtle Beach LLC | Prosthetic/Orthotic Supplier | 285 Meeting St, Charleston, SC 29401-1550 | 2009-04-23 |
| 1982884433 | Lehotay Prosthetics, LLC | Prosthetic/Orthotic Supplier | 624 Central Ave, Charleston, WV 25302-1912 | 2007-11-13 |
| 1548454242 | C Howell Shoes Inc | Prosthetic/Orthotic Supplier | 1755 Sam Rittenberg Blvd, Charleston, SC 29407-4927 | 2007-09-05 |
| 1770774895 | Adaptive Limb & Brace, LLC | Prosthetic/Orthotic Supplier | 1033 Wappoo Rd, Suite E, Charleston, SC 29407-6087 | 2007-08-05 |
| 1649203670 | Charleston Orthopedic Appliances Inc | Prosthetic/Orthotic Supplier | 1532 Kanawha Blvd W, Charleston, WV 25312-2533 | 2006-07-10 |
| 1811968720 | Active Mobility, LLC | Prosthetic/Orthotic Supplier | 18 Leinbach Dr, Unit E, Charleston, SC 29407-7916 | 2006-01-30 |
| Find all providers in CHARLESTON | ||||
| City | CHARLESTON |
| Zip Code | 25301 |
Please comment or provide details below to improve the information on MOUNTAIN STATE PROSTHETICS, LLC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.