| NPI | 1780068288 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIMOTHY D CROCKETT Financial Officer 317-587-0505 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Additional Taxonomies | 363L00000X Nurse Practitioner |
| Enumeration Date | 2015-07-14 |
| Last Update Date | 2024-11-14 |