| NPI | 1912011867 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RONALD L JACOBSON CEO 605-622-5125 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 332BX2000X Durable Medical Equipment & Medical Supplies, Oxygen Equipment & Supplies (Licence: SD 10525) |
| Additional Taxonomies | 335E00000X Prosthetic/Orthotic Supplier (Licence: SD 10525) |
| 3336I0012X Pharmacy, Institutional Pharmacy (Licence: SD 10525) | |
| Enumeration Date | 2006-08-18 |
| Last Update Date | 2007-10-22 |