| NPI | 1093782070 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KAREN MARIE VAUGHN AO 629-317-1465 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology |
| Additional Taxonomies | 2085R0204X Radiology, Vascular & Interventional Radiology |
| 2085N0700X | |
| 363AS0400X Physician Assistant, Surgical | |
| 363AM0700X Physician Assistant, Medical | |
| 2085N0904X | |
| 2085B0100X Radiology, Body Imaging | |
| 2085U0001X Radiology, Diagnostic Ultrasound | |
| 363A00000X Physician Assistant | |
| Enumeration Date | 2006-03-08 |
| Last Update Date | 2026-06-03 |