| NPI | 1821158692 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRENT SEWARD Executive Vice President Medical 208-336-1643 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies (Licence: ID DME159) |
| Additional Taxonomies | 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment |
| 332BP3500X Durable Medical Equipment & Medical Supplies, Parenteral & Enteral Nutrition (Licence: ID DME159) | |
| 332BX2000X Durable Medical Equipment & Medical Supplies, Oxygen Equipment & Supplies (Licence: ID DME159) | |
| 3336C0003X Pharmacy, Community/Retail Pharmacy | |
| Enumeration Date | 2006-12-11 |
| Last Update Date | 2022-05-09 |