| NPI | 1366897720 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARY-BETH BRUBECK Vice President Of Finance / CFO 304-525-3334 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center Federally Qualified Health Center (FQHC) |
| Additional Taxonomies | 207Y00000X Otolaryngology |
| 363LF0000X Nurse Practitioner Family | |
| Enumeration Date | 2016-05-04 |
| Last Update Date | 2022-03-31 |