NPI | 1134515166 |
---|---|
Entity Type | Organization |
Authorized Contact | JACLYN FISHER Credentialing 704-832-5383 |
Organization Subpart ? | Yes |
Primary Taxonomy | 302R00000X Health Maintenance Organization |
Additional Taxonomies | 305R00000X Preferred Provider Organization |
305S00000X Point of Service | |
Enumeration Date | 2015-04-07 |
Last Update Date | 2023-08-28 |