| NPI | 1144620683 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL JORDAN WEAVER Owner 870-569-4909 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: AR E6051) |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies |
| Enumeration Date | 2014-09-03 |
| Last Update Date | 2016-02-09 |