| NPI | 1629840905 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JASON CARNES LEWIS Owner 502-855-3919 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies |
| Additional Taxonomies | 208VP0014X Pain Medicine, Interventional Pain Medicine |
| Enumeration Date | 2023-10-30 |
| Last Update Date | 2023-10-30 |