| NPI | 1790868057 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROBERT EELLS Owner 515-244-0633 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP1100X Clinic/Center, Podiatric (Licence: IA 00571) |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies (Licence: IA 00571) |
| 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment (Licence: IA 00571) | |
| Enumeration Date | 2006-10-23 |
| Last Update Date | 2013-12-16 |