| NPI | 1215944343 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JACKIE BOLT Owner 864-271-8258 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332BX2000X Durable Medical Equipment & Medical Supplies, Oxygen Equipment & Supplies (Licence: SC 023515322) |
| Additional Taxonomies | 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment (Licence: SC 023515322) |
| 332BP3500X Durable Medical Equipment & Medical Supplies, Parenteral & Enteral Nutrition (Licence: SC 023515322) | |
| Enumeration Date | 2006-08-02 |
| Last Update Date | 2008-03-21 |