| NPI | 1356522916 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANTHONY B CHARLES Owner 573-636-7382 |
| Organization Subpart ? | No |
| Primary Taxonomy | 335E00000X Prosthetic/Orthotic Supplier (Licence: MO 0825) |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies (Licence: MO Certified Ped 0825) |
| 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment (Licence: MO 0825) | |
| Enumeration Date | 2007-11-23 |
| Last Update Date | 2016-12-12 |