NPI | 1902570021 |
---|---|
Entity Type | Organization |
Authorized Contact | HEATHER BAHNMAIER Insurance Credentialing Specialist 785-505-2988 |
Organization Subpart ? | No |
Primary Taxonomy | 261QM1300X Clinic/Center Multi-Specialty |
Enumeration Date | 2021-08-03 |
Last Update Date | 2024-05-22 |