| NPI | 1346867942 |
|---|---|
| Doing Business As | CENTERVILLE FAMILY MEDICINE |
| Entity Type | Organization |
| Authorized Contact | CARISSA FULLER Credentialing Coordinator 765-599-3534 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 261Q00000X |
| Enumeration Date | 2020-06-30 |
| Last Update Date | 2020-06-30 |