| NPI | 1891030128 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LISA M. HEMKER CFO 440-240-1655 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Additional Taxonomies | 207Q00000X Family Medicine |
| 207QA0505X Family Medicine, Adult Medicine | |
| 207R00000X Internal Medicine | |
| 207V00000X Obstetrics & Gynecology | |
| 208000000X Pediatrics | |
| 213E00000X Podiatrist | |
| 363LP0200X Nurse Practitioner, Pediatrics | |
| 363LP2300X Nurse Practitioner, Primary Care | |
| Enumeration Date | 2012-11-27 |
| Last Update Date | 2021-06-24 |