| NPI | 1275314148 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHARLES MICHAEL BUCY Senior Reimbursement Manager 844-614-2354 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208VP0000X Pain Medicine Pain Medicine |
| Additional Taxonomies | 261QI0500X Clinic/Center Infusion Therapy |
| 261QM1300X Clinic/Center Multi-Specialty | |
| Enumeration Date | 2023-10-09 |
| Last Update Date | 2025-05-16 |