| NPI | 1982242327 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LEONARDO R ORTEGA CEO 317-291-7422 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2019-12-17 |
| Last Update Date | 2021-01-22 |