| NPI | 1053810622 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | REBECCA RAGER Director Revenue Cycle 844-969-0686 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 207QG0300X Family Medicine, Geriatric Medicine |
| 207R00000X Internal Medicine | |
| 208000000X Pediatrics | |
| 2084N0400X Psychiatry & Neurology, Neurology | |
| 213E00000X Podiatrist | |
| Enumeration Date | 2018-02-08 |
| Last Update Date | 2025-01-10 |