| NPI | 1184373003 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PHILLIP BLEDSOE Owner 725-577-8636 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care |
| Additional Taxonomies | 207R00000X Internal Medicine |
| 261QM2500X Clinic/Center, Medical Specialty | |
| Enumeration Date | 2022-03-18 |
| Last Update Date | 2025-04-10 |