| NPI | 1336676923 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | REBECCA RAGER Director Revenue Cycle 844-969-0686 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IN 01078373A) |
| 207RE0101X Internal Medicine, Endocrinology, Diabetes & Metabolism (Licence: IN 01078373A) | |
| 225100000X Physical Therapist (Licence: IN 01078373A) | |
| Enumeration Date | 2017-05-15 |
| Last Update Date | 2025-01-14 |