| NPI | 1700269792 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MATTHEW JOSEPH BERRIA President 208-740-4518 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR1300X Clinic/Center, Rural Health (Licence: OR PA000913) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: OR PA000913) |
| Enumeration Date | 2015-07-08 |
| Last Update Date | 2023-08-16 |