| NPI | 1457707713 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MIKE KALBAUGH Credentialing Specialist 336-878-8824 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies (Licence: VA 0206000001) |
| Additional Taxonomies | 332BX2000X Durable Medical Equipment & Medical Supplies Oxygen Equipment & Supplies (Licence: VA 0206000001) |
| Enumeration Date | 2016-05-05 |
| Last Update Date | 2017-06-20 |