| NPI | 1013681485 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOY CLEVENGER Credentialing Agent 502-523-6695 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies |
| Enumeration Date | 2021-08-09 |
| Last Update Date | 2024-07-23 |