| NPI | 1942303086 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRACEY NAGEL CFO 317-576-1335 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center Federally Qualified Health Center (FQHC) |
| Additional Taxonomies | 347C00000X Private Vehicle |
| Enumeration Date | 2006-09-06 |
| Last Update Date | 2025-03-26 |