| NPI | 1023668183 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAY BAUMGARTNER CFO 574-267-7169 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Additional Taxonomies | 207Q00000X Family Medicine |
| 261QP2300X Clinic/Center, Primary Care | |
| Enumeration Date | 2019-09-19 |
| Last Update Date | 2025-10-29 |