| NPI | 1215279690 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROXANA KROUSE Owner 844-333-1478 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist |
| Additional Taxonomies | 282N00000X General Acute Care Hospital |
| 363A00000X Physician Assistant | |
| Enumeration Date | 2013-03-22 |
| Last Update Date | 2021-07-20 |