NPI | 1245221092 |
---|---|
Entity Type | Organization |
Authorized Contact | WENDY RUSSALESI Cco 484-246-9499 |
Organization Subpart ? | Yes |
Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies (Licence: TN 0000000780) |
Additional Taxonomies | 335E00000X Prosthetic/Orthotic Supplier |
332BX2000X Durable Medical Equipment & Medical Supplies, Oxygen Equipment & Supplies | |
332BP3500X Durable Medical Equipment & Medical Supplies, Parenteral & Enteral Nutrition | |
332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment | |
Enumeration Date | 2005-11-01 |
Last Update Date | 2025-10-13 |