| NPI | 1124193040 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CARLA ELLEN MILLER Owner 208-735-2252 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332BX2000X Durable Medical Equipment & Medical Supplies, Oxygen Equipment & Supplies (Licence: ID DME249) |
| Enumeration Date | 2006-11-24 |
| Last Update Date | 2011-09-21 |