| NPI | 1023157104 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MUSTAFA MORRIS Credentialing Specialist 202-715-6590 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Additional Taxonomies | 207R00000X Internal Medicine |
| 207V00000X Obstetrics & Gynecology | |
| 213E00000X Podiatrist | |
| 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) | |
| 332B00000X Durable Medical Equipment & Medical Supplies | |
| Enumeration Date | 2007-02-06 |
| Last Update Date | 2021-05-05 |