| NPI | 1083155972 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRITTANY SIEFERT Owner 307-756-2013 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies |
| 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment | |
| Enumeration Date | 2017-03-13 |
| Last Update Date | 2019-02-14 |