| NPI | 1407466535 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARY-BETH BRUBECK VP Finance, CFO 304-525-3334 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Additional Taxonomies | 208000000X Pediatrics |
| 363LF0000X Nurse Practitioner, Family | |
| Enumeration Date | 2020-08-04 |
| Last Update Date | 2021-03-19 |