NPI | 1861125932 |
---|---|
Entity Type | Organization |
Authorized Contact | WILLIAM CORTES Executive Director 219-703-2585 |
Organization Subpart ? | No |
Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
Additional Taxonomies | 207RE0101X Internal Medicine, Endocrinology, Diabetes & Metabolism |
Enumeration Date | 2022-07-06 |
Last Update Date | 2024-08-16 |