Specialty |
Taxonomy Code | Specialty Code | Provider Type | |
Customized Equipment |
332BC3200X | 87 | All Other Suppliers | |
Prosthetic/Orthotic Supplier |
335E00000X | 51 | Medical Supply Company with Orthotist |
| NPI Number | 1902930266 |
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| LBN Legal business name | BARBARA GATES MITCHEM | ||||
| Authorized official | BARBARA MITCHEM - (OWNER) | ||||
| Entity | Organization | ||||
| Organization subpart 1 | No | ||||
| Enumeration date | 03/16/2007 | ||||
| Last updated | 04/12/2011 - About 15 years ago | ||||
| Identifiers |
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