| NPI | 1508595034 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DONALD EMERSON DICK Primary Owner 270-352-4601 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QU0200X Clinic/Center, Urgent Care |
| Additional Taxonomies | 207P00000X Emergency Medicine |
| 207R00000X Internal Medicine | |
| 363A00000X Physician Assistant | |
| 363L00000X Nurse Practitioner | |
| Enumeration Date | 2022-06-09 |
| Last Update Date | 2022-06-28 |