| NPI | 1518249929 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRIAN W. GRANTHAM President 800-568-1441 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: AR E5998) |
| Additional Taxonomies | 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: AR E5998) |
| 207Q00000X Family Medicine (Licence: AR E5998) | |
| Enumeration Date | 2011-09-12 |
| Last Update Date | 2024-07-09 |