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 |