| NPI | 1003238635 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNIFER L JACKSON Senior Director Provider Enrollment 877-892-9815 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine |
| Additional Taxonomies | 207Q00000X Family Medicine |
| 208600000X Surgery | |
| 208G00000X Thoracic Surgery (Cardiothoracic Vascular Surgery) | |
| Enumeration Date | 2014-01-16 |
| Last Update Date | 2022-01-25 |