| NPI | 1588624696 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TANYA WINES Director, System Credentialing 567-585-0422 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 208000000X Pediatrics |
| 208600000X Surgery | |
| 261QR1300X Clinic/Center, Rural Health | |
| 207RC0000X Internal Medicine, Cardiovascular Disease | |
| 207RE0101X Internal Medicine, Endocrinology, Diabetes & Metabolism | |
| 207V00000X Obstetrics & Gynecology | |
| 207X00000X Orthopaedic Surgery | |
| 207R00000X Internal Medicine | |
| 207Y00000X Otolaryngology | |
| 207L00000X Anesthesiology | |
| Enumeration Date | 2006-03-23 |
| Last Update Date | 2023-10-04 |