| NPI | 1730173345 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN VAN EARNHART Family Practice Provider 618-697-1331 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 207R00000X Internal Medicine |
| Enumeration Date | 2005-09-09 |
| Last Update Date | 2026-05-05 |