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Specialty |
Taxonomy Code | Specialty Code | Provider Type | |
Adult Medicine |
207QA0505X | 08 | Physician/Family Practice |
| NPI Number | 1962673459 |
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| LBN Legal business name | OUR CLINIC, INC | ||||||||
| Authorized official | ROSE HOLMES - (MANAGER) | ||||||||
| Entity | Organization | ||||||||
| Organization subpart 1 | No | ||||||||
| Enumeration date | 03/12/2008 | ||||||||
| Last updated | 03/13/2008 - About 18 years ago | ||||||||
| Identifiers |
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OUR CLINIC, INC