| NPI | 1376002931 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CODEY D GILLUM CEO 617-393-1709 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical |
| Enumeration Date | 2019-03-13 |
| Last Update Date | 2022-03-26 |