| NPI | 1962804955 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CORY JACKSON Controller 814-333-5766 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine |
| Additional Taxonomies | 207Q00000X Family Medicine |
| 207QA0505X Family Medicine, Adult Medicine | |
| 207RG0300X Internal Medicine, Geriatric Medicine | |
| 363AM0700X Physician Assistant, Medical | |
| 363LF0000X Nurse Practitioner, Family | |
| 363LP2300X Nurse Practitioner, Primary Care | |
| Enumeration Date | 2014-09-22 |
| Last Update Date | 2024-12-18 |