| NPI | 1417486523 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JACQUELINE SNYDER Billing Manager 765-413-7100 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207QA0401X Family Medicine Addiction Medicine |
| Additional Taxonomies | 207QA0505X Family Medicine Adult Medicine |
| 207QB0002X Family Medicine Obesity Medicine | |
| 332900000X Non-Pharmacy Dispensing Site | |
| Enumeration Date | 2017-06-12 |
| Last Update Date | 2024-04-18 |