| NPI | 1093301624 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN T HACKBARTH Secretary 270-417-4813 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family |
| Enumeration Date | 2020-12-17 |
| Last Update Date | 2020-12-17 |