| NPI | 1619484102 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHAD WOOLNER CEO 208-639-1397 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies |
| Enumeration Date | 2018-01-05 |
| Last Update Date | 2020-07-07 |