| NPI | 1316602972 |
|---|---|
| Doing Business As | SOUTHWEST MEDICAL GROUP PARK STREET |
| Entity Type | Organization |
| Authorized Contact | RICK SHRADER CFO 941-483-7225 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care |
| Enumeration Date | 2021-11-08 |
| Last Update Date | 2021-11-08 |