| NPI | 1265324628 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHAD WARREN Owner 385-396-7235 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center Multi-Specialty |
| Additional Taxonomies | 208D00000X General Practice |
| 261QH0100X Clinic/Center Health Service | |
| 261QI0500X Clinic/Center Infusion Therapy | |
| 363LA2200X Nurse Practitioner Adult Health | |
| 261QM0850X Clinic/Center Adult Mental Health | |
| 202D00000X | |
| 2083B0002X Preventive Medicine Obesity Medicine | |
| Enumeration Date | 2025-07-18 |
| Last Update Date | 2025-07-18 |