| NPI | 1255958773 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DOUGLAS SPARKS Member Manager 800-714-1359 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies |
| Enumeration Date | 2020-06-30 |
| Last Update Date | 2020-10-22 |