| NPI | 1730235417 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHUCK MCMILLAN Owner 985-674-4170 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment (Licence: LA Z10781) |
| Additional Taxonomies | 335E00000X Prosthetic/Orthotic Supplier |
| Enumeration Date | 2007-01-26 |
| Last Update Date | 2012-04-23 |