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 |