| NPI | 1114393469 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LANCE GREEN CFO 863-687-1100 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice |
| Additional Taxonomies | 261QM1300X Clinic/Center, Multi-Specialty |
| 363A00000X Physician Assistant | |
| 363AS0400X Physician Assistant, Surgical | |
| 207VF0040X Obstetrics & Gynecology, Female Pelvic Medicine and Reconstructive Surgery | |
| Enumeration Date | 2015-08-20 |
| Last Update Date | 2023-04-10 |