| NPI | 1992480586 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TODD POLATTIS Authorized Official 208-709-3628 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies |
| Enumeration Date | 2023-06-20 |
| Last Update Date | 2024-06-25 |