| NPI | 1265976054 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEFFREY MATUKEICZ Secretary 423-756-2268 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies |
| 332BP3500X Durable Medical Equipment & Medical Supplies, Parenteral & Enteral Nutrition | |
| Enumeration Date | 2016-12-13 |
| Last Update Date | 2021-03-25 |