| NPI | 1497339857 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN BRADFORD CFO/AO 270-762-1100 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family |
| 208800000X Urology | |
| Enumeration Date | 2021-05-11 |
| Last Update Date | 2021-05-11 |