| NPI | 1104394329 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SCOTT C WALLACE Owner/Physician 765-284-0493 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology |
| Additional Taxonomies | 207LP3000X Anesthesiology, Pediatric Anesthesiology |
| Enumeration Date | 2018-11-06 |
| Last Update Date | 2020-01-16 |