| NPI | 1780051136 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KIRK SHAFER CFO 765-288-1928 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Additional Taxonomies | 207Q00000X Family Medicine |
| 207R00000X Internal Medicine | |
| Enumeration Date | 2015-09-01 |
| Last Update Date | 2015-09-01 |