| NPI | 1154203883 |
|---|---|
| Doing Business As | THE PROVIDER PARTNER |
| Entity Type | Organization |
| Authorized Contact | TRACY OLSTEN Chief Operations Officer 689-208-9583 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization |
| Enumeration Date | 2025-07-23 |
| Last Update Date | 2025-07-23 |