| NPI | 1710791173 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GROVER GLENDON KERNS VP Of Finance 304-260-1443 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery |
| 213ES0131X | |
| Enumeration Date | 2025-02-05 |
| Last Update Date | 2025-02-05 |