| NPI | 1205018207 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LYLE E. WADSWORTH President 386-740-0224 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME30902) |
| Additional Taxonomies | 207RG0300X Internal Medicine, Geriatric Medicine (Licence: FL ME30902) |
| 207RH0002X Internal Medicine, Hospice and Palliative Medicine (Licence: FL ME30902) | |
| Enumeration Date | 2007-11-30 |
| Last Update Date | 2008-03-06 |