| NPI | 1205406394 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANNE BAUMAN Chief Of Operations 567-661-0565 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 207RC0000X Internal Medicine Cardiovascular Disease |
| 207V00000X Obstetrics & Gynecology | |
| 261QF0400X Clinic/Center Federally Qualified Health Center (FQHC) | |
| Enumeration Date | 2021-06-30 |
| Last Update Date | 2025-03-11 |