NPI | 1134890833 |
---|---|
Entity Type | Organization |
Authorized Contact | RACHEL BLANKENSHIHP Credentialing Manager 304-429-1088 |
Organization Subpart ? | No |
Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty |
Additional Taxonomies | 122300000X Dentist |
261QD0000X Clinic/Center, Dental | |
261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) | |
Enumeration Date | 2021-09-22 |
Last Update Date | 2024-02-13 |