| NPI | 1649987066 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MERRY SCHUMACHER Sr. Director Provider Services 800-400-6354 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 208000000X Pediatrics |
| 207P00000X Emergency Medicine | |
| 207R00000X Internal Medicine | |
| Enumeration Date | 2022-11-04 |
| Last Update Date | 2023-06-23 |