| NPI | 1083095129 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LANCE GREEN VP / CFO 863-687-1100 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice |
| Additional Taxonomies | 207Q00000X Family Medicine |
| 261QM1300X Clinic/Center, Multi-Specialty | |
| 363A00000X Physician Assistant | |
| Enumeration Date | 2015-06-15 |
| Last Update Date | 2023-01-04 |