ID license #NP1660AID license #NP-1660Ataxonomy 363LF0000X
Clinic/Center
An entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to a specific area of medical specialization. Frequently used for Title V related Children's Specialty services or...
ID license #M-10400ID license #NP1660Ataxonomy 261QM2500X
Family Medicine
Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of...
ID license #M-10400taxonomy 207Q00000X
Other names on file (1)
Doing-business-as, former, and alternate names recorded by NPPES.
Medicare & Family Practice
Type code 3recorded 2017-04-28
Practice context
Multi-provider organization.
4 individual providers on file at this primary address.
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