| NPI | 1386409001 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TREVOR HODGES CEO 906-483-1846 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice |
| Enumeration Date | 2024-02-21 |
| Last Update Date | 2025-07-10 |