| NPI | 1033959770 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRAVIS OWEN CFO 385-377-9352 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center Primary Care |
| Additional Taxonomies | 207Q00000X Family Medicine |
| 207R00000X Internal Medicine | |
| 363L00000X Nurse Practitioner | |
| 363LP2300X Nurse Practitioner Primary Care | |
| Enumeration Date | 2024-05-30 |
| Last Update Date | 2024-09-11 |