| NPI | 1740268614 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MIKE KALBAUGH Credentialing Specialist 336-878-8824 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332BX2000X Durable Medical Equipment & Medical Supplies, Oxygen Equipment & Supplies (Licence: NC 00786) |
| Additional Taxonomies | 332BP3500X Durable Medical Equipment & Medical Supplies, Parenteral & Enteral Nutrition (Licence: NC 05113) |
| 333600000X Pharmacy (Licence: NC 05113) | |
| 251F00000X Home Infusion (Licence: NC 05113) | |
| 332B00000X Durable Medical Equipment & Medical Supplies | |
| 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment (Licence: NC 00786) | |
| 3336H0001X Pharmacy, Home Infusion Therapy Pharmacy (Licence: NC 0533) | |
| Enumeration Date | 2006-01-02 |
| Last Update Date | 2018-11-16 |