| NPI | 1134542673 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KILEY ANN RUSSELL Director Of Payor Relations 629-252-8211 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies |
| 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 | 2014-02-03 |
| Last Update Date | 2023-03-16 |