NPI | 1538940028 |
---|---|
Entity Type | Organization |
Authorized Contact | AMANDA GOTTS Credentialing Specialist 208-509-3088 |
Organization Subpart ? | No |
Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies |
Additional Taxonomies | 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment |
332BX2000X Durable Medical Equipment & Medical Supplies, Oxygen Equipment & Supplies | |
335E00000X Prosthetic/Orthotic Supplier | |
Enumeration Date | 2023-10-10 |
Last Update Date | 2025-01-23 |