| NPI | 1316340417 |
|---|---|
| Other Name | PINE BLUFFS CLINIC |
| Entity Type | Organization |
| Authorized Contact | RONALD MALM Program Director 307-632-2434 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QF0400X Clinic/Center Federally Qualified Health Center (FQHC) |
| Additional Taxonomies | 261Q00000X Clinic/Center |
| Enumeration Date | 2014-10-02 |
| Last Update Date | 2016-04-13 |