| NPI | 1114906906 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KIMBERLY SLOBODNIK Accounts Rec Manager 712-325-1990 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Additional Taxonomies | 261QD0000X Clinic/Center, Dental |
| Enumeration Date | 2006-01-11 |
| Last Update Date | 2023-01-18 |