| NPI | 1104986983 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRENT SEWARD Exe Vice President Medical 208-336-1643 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies (Licence: ID DME109) |
| Additional Taxonomies | 332BC3200X Durable Medical Equipment & Medical Supplies Customized Equipment |
| 332BP3500X Durable Medical Equipment & Medical Supplies Parenteral & Enteral Nutrition | |
| 332BX2000X Durable Medical Equipment & Medical Supplies Oxygen Equipment & Supplies | |
| 335E00000X Prosthetic/Orthotic Supplier | |
| Enumeration Date | 2006-12-11 |
| Last Update Date | 2023-08-07 |