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 #M3561taxonomy 261QM2500X
Identifiers
Type
Value
Notes
05 (ID)
002451500
01 (ID)
35618
BLUE CROSS
01 (ID)
000010001844
BLUE SHIELD
Practice context
Multi-provider organization.
1 individual provider on file at this primary address.
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