| NPI | 1114009024 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MIKE KALBAUGH Credentialing Specialist 336-878-8824 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies (Licence: NC TO BE ISSUED) |
| Additional Taxonomies | 332BC3200X Durable Medical Equipment & Medical Supplies Customized Equipment (Licence: NC TO BE ISSUED) |
| 332BP3500X Durable Medical Equipment & Medical Supplies Parenteral & Enteral Nutrition (Licence: NC TO BE ISSUED) | |
| 332BX2000X Durable Medical Equipment & Medical Supplies Oxygen Equipment & Supplies (Licence: NC TO BE ISSUED) | |
| Enumeration Date | 2006-10-19 |
| Last Update Date | 2017-11-21 |