An outpatient entity, facility, or distinct part of a facility within or affiliated with a Critical Access Hospital that provides access to primary care services for individuals in a small rural community and is Medicare certified.
| Specialty | Taxonomy Code | |
|---|---|---|
| * | Critical Access Hospital | 261QC0050X |
* Indicates primary specialty
| NPI Number | 1972660488 |
| Legal business name LBN |
DIVINE PROVIDENCE MEDICAL CLINIC |
| Authorized official | GREGORY WILSON - (CEO) |
| Entity | Organization |
| Organization subpart | No |
| Enumeration date | 01/03/2007 |
| Last updated | 08/22/2020 - About 6 years ago |
| Sole proprietor1 | Not specified |
| Identifiers |
|
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.
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