| NPI | 1902140791 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MATHEW K SHOTWELL Owner/Physician 859-744-0263 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207RC0000X Internal Medicine, Cardiovascular Disease (Licence: KY 35596) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: KY 3007563) |
| 363A00000X Physician Assistant (Licence: KY PA562) | |
| Enumeration Date | 2012-11-16 |
| Last Update Date | 2015-10-16 |