| NPI | 1891166815 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KILEY ANN RUSSELL Senior Director Of Payor Relations 629-252-8211 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies |
| Additional Taxonomies | 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment |
| Enumeration Date | 2015-10-16 |
| Last Update Date | 2025-02-18 |