| NPI | 1003002759 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PETER RADICE Medical Director 855-232-0644 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME0086161) |
| Additional Taxonomies | 213EP1101X Podiatrist, Primary Podiatric Medicine |
| 152W00000X Optometrist | |
| 363LA2200X Nurse Practitioner, Adult Health | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health | |
| 208D00000X General Practice | |
| Enumeration Date | 2007-09-17 |
| Last Update Date | 2026-05-28 |