| NPI | 1467854661 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KIRK SHAFER C.F.O. 765-288-1928 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Additional Taxonomies | 207Q00000X Family Medicine |
| 207R00000X Internal Medicine | |
| 2084P0800X Psychiatry & Neurology, Psychiatry | |
| Enumeration Date | 2014-09-18 |
| Last Update Date | 2016-07-20 |