| NPI | 1508411828 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAMES R HAGER CEO 606-218-6077 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner |
| Additional Taxonomies | 207Q00000X Family Medicine |
| 363A00000X Physician Assistant | |
| Enumeration Date | 2019-08-04 |
| Last Update Date | 2019-10-11 |