| NPI | 1972054609 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROBERT ELLISON Director 217-479-5890 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QR1300X Clinic/Center, Rural Health |
| Additional Taxonomies | 207Q00000X Family Medicine |
| 207R00000X Internal Medicine | |
| 207Y00000X Otolaryngology | |
| Enumeration Date | 2016-10-18 |
| Last Update Date | 2017-04-04 |