| NPI | 1093044521 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KRISTIE M WHITLATCH CEO/President 606-408-4401 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208600000X Surgery |
| Additional Taxonomies | 363A00000X Physician Assistant |
| 363AS0400X Physician Assistant, Surgical | |
| 363L00000X Nurse Practitioner | |
| Enumeration Date | 2009-12-11 |
| Last Update Date | 2022-04-14 |