| NPI | 1851975387 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN BRADFORD CFO/AO 270-762-1100 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty |
| Additional Taxonomies | 207R00000X Internal Medicine |
| 207RG0100X Internal Medicine, Gastroenterology | |
| 363A00000X Physician Assistant | |
| 363AM0700X Physician Assistant, Medical | |
| 363LF0000X Nurse Practitioner, Family | |
| 364SA2200X Clinical Nurse Specialist, Adult Health | |
| Enumeration Date | 2021-05-11 |
| Last Update Date | 2021-05-11 |