| NPI | 1841643327 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | REBECCA RAGER Director Revenue Cycle 844-969-0686 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 207R00000X Internal Medicine |
| 207RE0101X Internal Medicine, Endocrinology, Diabetes & Metabolism | |
| 2084N0400X Psychiatry & Neurology, Neurology | |
| 213ES0103X Podiatrist, Foot & Ankle Surgery | |
| 225100000X Physical Therapist | |
| 363A00000X Physician Assistant | |
| 363L00000X Nurse Practitioner | |
| Enumeration Date | 2016-07-19 |
| Last Update Date | 2025-01-10 |