| NPI | 1124072681 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SUE FUCIARELLI Vice President For Finance And Admi 915-215-4300 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 183500000X Pharmacist |
| 207P00000X Emergency Medicine | |
| 363A00000X Physician Assistant | |
| Enumeration Date | 2006-05-20 |
| Last Update Date | 2022-04-18 |