| NPI | 1548883812 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEFFREY W HOWARD CFO 800-355-3565 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QC1500X Clinic/Center, Community Health |
| Additional Taxonomies | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| 261QM1300X Clinic/Center, Multi-Specialty | |
| Enumeration Date | 2020-05-21 |
| Last Update Date | 2020-09-30 |