| NPI | 1104206499 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHARON CLARK National Contract Mgr. 512-806-2879 |
| Organization Subpart ? | No |
| Primary Taxonomy | 335E00000X Prosthetic/Orthotic Supplier |
| Additional Taxonomies | 224P00000X Prosthetist |
| 332B00000X Durable Medical Equipment & Medical Supplies (Licence: NC 02286) | |
| 332BC3200X Durable Medical Equipment & Medical Supplies Customized Equipment | |
| Enumeration Date | 2015-06-02 |
| Last Update Date | 2022-05-27 |