| NPI | 1407108335 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRANDI OOM CEO 913-367-4879 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Additional Taxonomies | 122300000X Dentist |
| 261QC1500X Clinic/Center, Community Health | |
| Enumeration Date | 2012-10-02 |
| Last Update Date | 2024-09-25 |