| NPI | 1407642366 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALEXANDER INGRAM Member 267-455-8455 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical |
| Additional Taxonomies | 207RG0100X Internal Medicine, Gastroenterology |
| Enumeration Date | 2025-04-17 |
| Last Update Date | 2025-04-17 |