| NPI | 1679321368 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JUSTIN GIBSON VP, Finance 304-598-4256 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 207Y00000X Otolaryngology |
| Additional Taxonomies | 363A00000X Physician Assistant |
| 363L00000X Nurse Practitioner | |
| Enumeration Date | 2024-05-08 |
| Last Update Date | 2025-03-18 |