| NPI | 1922408921 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AARON CHARLES LUCKEY Owner 210-824-1112 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies |
| Additional Taxonomies | 332BP3500X Durable Medical Equipment & Medical Supplies Parenteral & Enteral Nutrition |
| 332BX2000X Durable Medical Equipment & Medical Supplies Oxygen Equipment & Supplies | |
| Enumeration Date | 2014-08-26 |
| Last Update Date | 2018-01-12 |