| NPI | 1699727495 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WENDY CARSON Manager, Payer Enrollment 234-312-5691 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery |
| Additional Taxonomies | 207XS0106X Orthopaedic Surgery Hand Surgery |
| 207XS0117X Orthopaedic Surgery Orthopaedic Surgery of the Spine | |
| 207XX0801X Orthopaedic Surgery Orthopaedic Trauma | |
| 213ES0103X Podiatrist Foot & Ankle Surgery | |
| 363A00000X Physician Assistant | |
| 363L00000X Nurse Practitioner | |
| 364S00000X Clinical Nurse Specialist | |
| 207QS0010X Family Medicine Sports Medicine | |
| Enumeration Date | 2006-05-17 |
| Last Update Date | 2024-09-30 |