| NPI | 1053742916 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MERRY SCHUMACHER Sr. Director Provider Services 800-400-6354 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 101Y00000X Counselor |
| 103T00000X Psychologist | |
| 104100000X Social Worker | |
| 207P00000X Emergency Medicine | |
| 207R00000X Internal Medicine | |
| 208000000X Pediatrics | |
| 208D00000X General Practice | |
| Enumeration Date | 2013-12-03 |
| Last Update Date | 2022-11-04 |