| NPI | 1245282979 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KRISTINA MUSIC Dir Prov Enrollment 877-892-9815 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine |
| Additional Taxonomies | 152W00000X Optometrist |
| 156FX1800X Technician/Technologist, Optician | |
| 207N00000X Dermatology | |
| 207Q00000X Family Medicine | |
| 207Y00000X Otolaryngology | |
| 207RC0000X Internal Medicine, Cardiovascular Disease | |
| 207RG0300X Internal Medicine, Geriatric Medicine | |
| 208000000X Pediatrics | |
| 207RP1001X Internal Medicine, Pulmonary Disease | |
| 207W00000X Ophthalmology | |
| 208600000X Surgery | |
| 208800000X Urology | |
| 208M00000X Hospitalist | |
| 208VP0000X | |
| Enumeration Date | 2006-05-17 |
| Last Update Date | 2025-07-24 |