| NPI | 1275356560 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KEVIN SCOTT MACNIVEN CEO 877-328-7112 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine |
| Additional Taxonomies | 207Q00000X Family Medicine |
| 207RC0000X Internal Medicine, Cardiovascular Disease | |
| 207RG0100X Internal Medicine, Gastroenterology | |
| 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine | |
| 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine | |
| 2084N0008X Psychiatry & Neurology, Neuromuscular Medicine | |
| 213E00000X Podiatrist | |
| 213ES0000X Podiatrist, Sports Medicine | |
| 213ES0103X Podiatrist, Foot & Ankle Surgery | |
| Enumeration Date | 2024-11-05 |
| Last Update Date | 2024-11-05 |