NPI | 1720347305 |
---|---|
Entity Type | Organization |
Authorized Contact | KIRK W SHAFER C.F.O. 765-288-1928 |
Organization Subpart ? | No |
Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
Additional Taxonomies | 207Q00000X Family Medicine |
Enumeration Date | 2012-05-16 |
Last Update Date | 2016-07-20 |