| NPI | 1013629963 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LEOLA MCMILLAN Practitioner 336-918-8521 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QV0200X Clinic/Center, VA |
| Additional Taxonomies | 174400000X Specialist |
| 1744P3200X Specialist, Prosthetics Case Management | |
| 224P00000X Prosthetist | |
| 332B00000X Durable Medical Equipment & Medical Supplies | |
| 335E00000X Prosthetic/Orthotic Supplier | |
| Enumeration Date | 2022-12-21 |
| Last Update Date | 2024-05-02 |