| NPI | 1801607171 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TAMMY J GAVIN Practice Admin/Credentialing 662-370-1014 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies |
| Enumeration Date | 2025-01-16 |
| Last Update Date | 2025-01-16 |