| NPI | 1104982644 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MIKE KALBAUGH Credentialing Specialist 336-878-8824 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332BP3500X Durable Medical Equipment & Medical Supplies, Parenteral & Enteral Nutrition (Licence: NC HC0820) |
| Additional Taxonomies | 251F00000X Home Infusion (Licence: NC HC0297) |
| Enumeration Date | 2006-12-29 |
| Last Update Date | 2017-11-21 |