| NPI | 1770808362 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KIRK SHAFER Vice President Of Finance 765-288-1928 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IN 422-0-CMHC) |
| Enumeration Date | 2010-04-07 |
| Last Update Date | 2016-07-20 |