| NPI | 1114441441 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RYAN N. GREGERSON President 800-555-1518 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies |
| Additional Taxonomies | 335E00000X Prosthetic/Orthotic Supplier |
| Enumeration Date | 2017-07-28 |
| Last Update Date | 2021-12-27 |