NPI | 1306568043 |
---|---|
Entity Type | Organization |
Authorized Contact | SHANA BUSH Credentialing Specialist 479-437-3449 |
Organization Subpart ? | No |
Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
Enumeration Date | 2022-09-19 |
Last Update Date | 2024-01-17 |