| NPI | 1891939682 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CARMEN HENDERSON Credentials Specialist 614-457-3212 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QP1100X Clinic/Center, Podiatric (Licence: MI 5901002275) |
| Additional Taxonomies | 335E00000X Prosthetic/Orthotic Supplier (Licence: MI 5901002275) |
| 332B00000X Durable Medical Equipment & Medical Supplies (Licence: MI 5901002275) | |
| Enumeration Date | 2009-04-24 |
| Last Update Date | 2009-11-04 |