| NPI | 1144533670 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNIFER L JACKSON Senior Director Provider Enrollment 877-892-9815 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208600000X Surgery |
| Additional Taxonomies | 207T00000X Neurological Surgery |
| 2086X0206X Surgery, Surgical Oncology | |
| Enumeration Date | 2010-07-26 |
| Last Update Date | 2022-01-25 |