| NPI | 1972589430 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CINDY K TROGLIN Billing Mgr Medicare Medicaid Spe 903-567-4129 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies |
| Additional Taxonomies | 333600000X Pharmacy (Licence: TX 01827) |
| Enumeration Date | 2005-12-16 |
| Last Update Date | 2012-04-10 |