| NPI | 1760189013 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | EBONI JANUARY CEO 573-268-4830 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center Primary Care |
| Additional Taxonomies | 207R00000X Internal Medicine |
| 261QC1500X Clinic/Center Community Health | |
| 261QE0700X Clinic/Center End-Stage Renal Disease (ESRD) Treatment | |
| 261QI0500X Clinic/Center Infusion Therapy | |
| 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) | |
| 261QP0904X Clinic/Center Public Health, Federal | |
| 261QR0200X Clinic/Center Radiology | |
| 261QR0405X Clinic/Center Rehabilitation, Substance Use Disorder | |
| 261QR1100X Clinic/Center Research | |
| 261QV0200X Clinic/Center VA | |
| 291U00000X Clinical Medical Laboratory | |
| Enumeration Date | 2023-02-07 |
| Last Update Date | 2023-02-08 |