| NPI | 1407361736 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JESSICA WELBORN Executive Director 406-531-6789 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332BP3500X Durable Medical Equipment & Medical Supplies, Parenteral & Enteral Nutrition |
| Additional Taxonomies | 174400000X Specialist |
| Enumeration Date | 2017-12-08 |
| Last Update Date | 2017-12-15 |