| NPI | 1548950173 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEBORAH A GOSS Credentialing 208-221-1161 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment |
| Enumeration Date | 2023-05-08 |
| Last Update Date | 2023-05-08 |