| NPI | 1558428896 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DONN SORENSEN Chief Operating Officer 417-829-4264 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies |
| Additional Taxonomies | 207N00000X Dermatology (Licence: MO 110288) |
| 207W00000X Ophthalmology (Licence: MO R4G22) | |
| 207X00000X Orthopaedic Surgery (Licence: MO 2000146094) | |
| 207Y00000X Otolaryngology (Licence: MO 100206) | |
| 208200000X Plastic Surgery (Licence: MO R4611) | |
| Enumeration Date | 2007-01-03 |
| Last Update Date | 2012-02-07 |