| NPI | 1386652089 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JACKIE M BOLT Owner 864-271-8258 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332BX2000X Durable Medical Equipment & Medical Supplies, Oxygen Equipment & Supplies |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies |
| 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment | |
| 332BP3500X Durable Medical Equipment & Medical Supplies, Parenteral & Enteral Nutrition | |
| Enumeration Date | 2006-08-04 |
| Last Update Date | 2022-07-21 |