| NPI | 1184040719 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KEITH JASON HEBERT Owner 866-542-3020 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332BP3500X Durable Medical Equipment & Medical Supplies, Parenteral & Enteral Nutrition |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies |
| Enumeration Date | 2014-03-06 |
| Last Update Date | 2021-09-01 |