| NPI | 1053828079 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ERIK DAVID MICKELSON Owner 509-941-5191 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies |
| Additional Taxonomies | 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment |
| 332BP3500X Durable Medical Equipment & Medical Supplies, Parenteral & Enteral Nutrition | |
| 332BX2000X Durable Medical Equipment & Medical Supplies, Oxygen Equipment & Supplies | |
| Enumeration Date | 2017-12-29 |
| Last Update Date | 2023-02-07 |