| NPI | 1073994935 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CASSANDRA R SMITH-ROSS Crentialing Specialist 920-858-4533 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies |
| Additional Taxonomies | 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment (Licence: MD C17849) |
| Enumeration Date | 2015-06-16 |
| Last Update Date | 2015-06-22 |