| NPI | 1720075161 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TYLER THOMPSON Administrator 417-256-2111 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR1300X Clinic/Center, Rural Health |
| Additional Taxonomies | 207Q00000X Family Medicine |
| Enumeration Date | 2005-09-30 |
| Last Update Date | 2023-05-02 |