| NPI | 1063967768 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SVJATOSLAV JAKOVLEV Owner 601-786-0888 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies |
| Additional Taxonomies | 332BD1200X Durable Medical Equipment & Medical Supplies, Dialysis Equipment & Supplies |
| 332BP3500X Durable Medical Equipment & Medical Supplies, Parenteral & Enteral Nutrition | |
| 332BX2000X Durable Medical Equipment & Medical Supplies, Oxygen Equipment & Supplies | |
| Enumeration Date | 2016-08-23 |
| Last Update Date | 2022-11-30 |