| NPI | 1316243371 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHNNY B GREEN President 208-377-2273 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: ID M11186) |
| Additional Taxonomies | 208600000X Surgery (Licence: ID M11186) |
| Enumeration Date | 2011-02-08 |
| Last Update Date | 2011-03-22 |