| NPI | 1164893491 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DONALD A SIMILA CEO 906-483-1325 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice |
| Enumeration Date | 2015-10-13 |
| Last Update Date | 2024-11-11 |