| NPI | 1629649751 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVID HALL CEO 219-763-8112 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center Federally Qualified Health Center (FQHC) |
| Additional Taxonomies | 207Q00000X Family Medicine |
| 261QM1300X Clinic/Center Multi-Specialty | |
| 363LF0000X Nurse Practitioner Family | |
| Enumeration Date | 2021-07-09 |
| Last Update Date | 2021-07-09 |