| NPI | 1972743557 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEFFREY MATUKEWICZ Secretary 423-756-2268 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment (Licence: TX 0107432) |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies |
| 332BP3500X Durable Medical Equipment & Medical Supplies, Parenteral & Enteral Nutrition (Licence: TX 0107432) | |
| 332BX2000X Durable Medical Equipment & Medical Supplies, Oxygen Equipment & Supplies (Licence: TX 0107432) | |
| Enumeration Date | 2009-02-23 |
| Last Update Date | 2021-03-25 |