| NPI | 1336679836 |
|---|---|
| Doing Business As | NORTHEAST FAMILY HEALTH ANNEX |
| Entity Type | Organization |
| Authorized Contact | ANDREW GRIMM CEO 660-627-5757 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103T00000X Psychologist |
| Additional Taxonomies | 207Q00000X Family Medicine |
| 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) | |
| Enumeration Date | 2017-06-16 |
| Last Update Date | 2017-07-10 |