NPI | 1053917948 |
---|---|
Entity Type | Organization |
Authorized Contact | TERRANCE MORTON Cmo 740-607-4835 |
Organization Subpart ? | No |
Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family |
363L00000X Nurse Practitioner | |
1041C0700X Social Worker, Clinical | |
207R00000X Internal Medicine | |
207Q00000X Family Medicine | |
Enumeration Date | 2020-12-07 |
Last Update Date | 2025-10-13 |