| NPI | 1659515815 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RUSCELL D. PAVLIN Medicare Manager 417-380-5105 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332BX2000X Durable Medical Equipment & Medical Supplies, Oxygen Equipment & Supplies (Licence: OH RSOX. 021908350) |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies (Licence: OH HMER. 22583) |
| Enumeration Date | 2009-04-30 |
| Last Update Date | 2010-05-04 |