NPI | 1700458981 |
---|---|
Entity Type | Organization |
Authorized Contact | KATE BOGUE Credentialing 719-632-4455 |
Organization Subpart ? | Yes |
Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty |
Additional Taxonomies | 208000000X Pediatrics |
Enumeration Date | 2021-07-15 |
Last Update Date | 2021-07-23 |