| NPI | 1578441200 | 
|---|---|
| Entity Type | Organization | 
| Authorized Contact | JAGADEESH JAGARLAMUDI Operations Administrator 332-296-0021 | 
| Organization Subpart ? | No | 
| Primary Taxonomy | 207Q00000X Family Medicine | 
| Additional Taxonomies | 207R00000X Internal Medicine | 
| Enumeration Date | 2025-08-21 | 
| Last Update Date | 2025-08-21 |