| NPI | 1184671844 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JACK MEADOWS MATHENY Owner 386-328-6746 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 207R00000X Internal Medicine |
| Enumeration Date | 2006-05-28 |
| Last Update Date | 2024-09-12 |