| NPI | 1639172331 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | REBECCA MORRIS Insurance Contracts Manager 217-342-3412 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment (Licence: IL 203000238) |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies (Licence: IL 203000238) |
| 335E00000X Prosthetic/Orthotic Supplier (Licence: IL 203000238) | |
| Enumeration Date | 2005-05-27 |
| Last Update Date | 2024-05-15 |