| NPI | 1609020221 |
|---|---|
| Former Legal Business Name | MAVERICK GROUP, LLC |
| Entity Type | Organization |
| Authorized Contact | SCOTT KITTLESON President/Owner 502-225-4772 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332BX2000X Durable Medical Equipment & Medical Supplies, Oxygen Equipment & Supplies (Licence: KY MG0450) |
| Enumeration Date | 2008-11-10 |
| Last Update Date | 2008-11-10 |