| NPI | 1568625648 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHAD STEVENS CFO 606-526-9005 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Additional Taxonomies | 122300000X Dentist |
| 103TC0700X Psychologist, Clinical | |
| 207Q00000X Family Medicine | |
| 261QP2300X Clinic/Center, Primary Care | |
| 208M00000X Hospitalist | |
| 103T00000X Psychologist | |
| 1223G0001X Dentist, General Practice | |
| 363L00000X Nurse Practitioner | |
| Enumeration Date | 2008-07-08 |
| Last Update Date | 2025-10-07 |