| NPI | 1689642969 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WALTER JOHNSON Credentialing And Licensure Manager 314-447-7515 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment (Licence: DE 1997119307) |
| Additional Taxonomies | 171WH0202X Contractor, Home Modifications |
| 332B00000X Durable Medical Equipment & Medical Supplies | |
| Enumeration Date | 2006-03-10 |
| Last Update Date | 2023-05-12 |