| NPI | 1053757526 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LANCE GREEN VP, CFO 863-687-1100 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center Multi-Specialty |
| Additional Taxonomies | 207Q00000X Family Medicine |
| 208000000X Pediatrics | |
| 208D00000X General Practice | |
| 363LP0200X Nurse Practitioner Pediatrics | |
| Enumeration Date | 2013-05-10 |
| Last Update Date | 2023-01-04 |