| NPI | 1518972181 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WILLIAM C CLEMENTS Owner/President 662-240-0460 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies (Licence: MS 04683/02.5) |
| Additional Taxonomies | 332BX2000X Durable Medical Equipment & Medical Supplies, Oxygen Equipment & Supplies (Licence: MS 04683/02.5) |
| 3336C0003X Pharmacy, Community/Retail Pharmacy (Licence: MS 04683/02.5) | |
| 335E00000X Prosthetic/Orthotic Supplier (Licence: MS 04683/02.5) | |
| Enumeration Date | 2006-07-30 |
| Last Update Date | 2020-08-22 |