| NPI | 1164105110 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WILLIAM CORTES Executive Director 219-703-2585 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center Federally Qualified Health Center (FQHC) |
| Additional Taxonomies | 207Q00000X Family Medicine |
| 363LF0000X Nurse Practitioner Family | |
| Enumeration Date | 2023-08-08 |
| Last Update Date | 2024-08-16 |