| NPI | 1215978630 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHELSEY CONWAY VP Finance 267-845-4119 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine |
| 208100000X Physical Medicine & Rehabilitation | |
| Enumeration Date | 2006-06-09 |
| Last Update Date | 2023-01-17 |