| NPI | 1467150086 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KAREN SHEPHERD Director Revenue Cycle 833-378-4827 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Additional Taxonomies | 207Q00000X Family Medicine |
| Enumeration Date | 2023-02-22 |
| Last Update Date | 2025-01-02 |