| NPI | 1396053286 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAWNE H TUNKEL Credentialing Direct 865-531-0176 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: GA 1744OOOOOX) |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies (Licence: GA 332BOOOOOX) |
| Enumeration Date | 2010-09-14 |
| Last Update Date | 2013-02-26 |