NPI | 1528764784 |
---|---|
Entity Type | Organization |
Authorized Contact | ALANDA K TILLMAN Provider 601-384-4532 |
Organization Subpart ? | No |
Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies |
Additional Taxonomies | 335E00000X Prosthetic/Orthotic Supplier |
Enumeration Date | 2023-01-31 |
Last Update Date | 2023-07-17 |