| NPI | 1265978290 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LANCE CHAD HAAS Administrative Manager/Owner 239-265-9760 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207QA0505X Family Medicine, Adult Medicine |
| Additional Taxonomies | 208D00000X General Practice |
| 261QR1300X Clinic/Center, Rural Health | |
| 363L00000X Nurse Practitioner | |
| Enumeration Date | 2017-01-14 |
| Last Update Date | 2019-07-12 |