| NPI | 1023668183 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAY BAUMGARTNER CFO 574-267-7169 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 261QP2300X Clinic/Center, Primary Care |
| Enumeration Date | 2019-09-19 |
| Last Update Date | 2021-01-12 |