| NPI | 1164113742 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MITCHELL PAUL RIDER Podiatrist 979-922-9800 |
| Organization Subpart ? | No |
| Primary Taxonomy | 313M00000X Nursing Facility/Intermediate Care Facility |
| Additional Taxonomies | 261Q00000X Clinic/Center |
| Enumeration Date | 2023-05-16 |
| Last Update Date | 2023-05-16 |