| NPI | 1417542762 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BETH LONGERBEAM Executive Assistant 270-506-2730 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine |
| Additional Taxonomies | 207RC0000X Internal Medicine Cardiovascular Disease |
| 207W00000X Ophthalmology | |
| 2084P0804X Psychiatry & Neurology Child & Adolescent Psychiatry | |
| 2085B0100X Radiology Body Imaging | |
| Enumeration Date | 2021-03-08 |
| Last Update Date | 2021-03-16 |