| NPI | 1689338691 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KILEY ANN RUSSELL Senior Director Of Payor Relations 629-252-8211 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies |
| Additional Taxonomies | 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment |
| 332BP3500X Durable Medical Equipment & Medical Supplies, Parenteral & Enteral Nutrition | |
| Enumeration Date | 2021-10-26 |
| Last Update Date | 2024-04-17 |