| NPI | 1861184145 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMANDA GOTTS Credentialing Specialist 208-509-3088 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies |
| 332BX2000X Durable Medical Equipment & Medical Supplies, Oxygen Equipment & Supplies | |
| 335E00000X Prosthetic/Orthotic Supplier | |
| Enumeration Date | 2023-05-24 |
| Last Update Date | 2023-05-24 |