NPI | 1346791167 |
---|---|
Entity Type | Organization |
Authorized Contact | CINDY KAVANAGH Accountant 217-788-2300 |
Organization Subpart ? | No |
Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
Additional Taxonomies | 207Q00000X Family Medicine |
363L00000X Nurse Practitioner | |
Enumeration Date | 2016-10-17 |
Last Update Date | 2016-10-17 |