| NPI | 1669564233 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KIM F WAGNER Owner 812-438-2338 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies (Licence: IN 000000) |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies |
| Enumeration Date | 2006-09-29 |
| Last Update Date | 2014-07-24 |