| NPI | 1942312020 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DANIEL EDWARDS Director 731-584-1058 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332BN1400X Durable Medical Equipment & Medical Supplies, Nursing Facility Supplies (Licence: TN 0606) |
| Additional Taxonomies | 332BP3500X Durable Medical Equipment & Medical Supplies, Parenteral & Enteral Nutrition (Licence: TN 0606) |
| 332BX2000X Durable Medical Equipment & Medical Supplies, Oxygen Equipment & Supplies (Licence: TN 0606) | |
| 332B00000X Durable Medical Equipment & Medical Supplies (Licence: TN 0606) | |
| 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment (Licence: TN 0606) | |
| 332BD1200X Durable Medical Equipment & Medical Supplies, Dialysis Equipment & Supplies (Licence: TN 0606) | |
| 335E00000X Prosthetic/Orthotic Supplier (Licence: TN 0606) | |
| 251F00000X Home Infusion (Licence: TN 0606) | |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2020-08-22 |