| NPI | 1538129002 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JANE C VENIARD Program Administrator 904-360-7070 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care |
| Additional Taxonomies | 122300000X Dentist |
| 231H00000X Audiologist | |
| 251B00000X Case Management | |
| Enumeration Date | 2006-03-27 |
| Last Update Date | 2020-08-22 |