| NPI | 1417153172 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEBBIE BREWER Director Of Provider Enrollment 877-892-9813 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208600000X Surgery |
| Additional Taxonomies | 207RC0000X Internal Medicine, Cardiovascular Disease |
| 207R00000X Internal Medicine | |
| Enumeration Date | 2007-06-21 |
| Last Update Date | 2007-12-06 |