| NPI | 1760474852 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHELLE L JACKSON Billing Specialist 304-225-6290 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies (Licence: WV CONTROLNUMBER72117) |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies (Licence: WV 770649) |
| Enumeration Date | 2005-08-16 |
| Last Update Date | 2022-05-19 |