NPI | 1194341594 |
---|---|
Entity Type | Organization |
Authorized Contact | MEREDITH MICHELLE HEISHMAN Credentialing 304-897-5915 |
Organization Subpart ? | No |
Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
Additional Taxonomies | 207Q00000X Family Medicine |
Enumeration Date | 2020-06-22 |
Last Update Date | 2020-06-22 |