| NPI | 1124693866 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | IVAN FERGUSON Owner 754-701-1510 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies |
| Additional Taxonomies | 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment |
| Enumeration Date | 2021-05-25 |
| Last Update Date | 2022-06-20 |