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Specialty |
Taxonomy Code | Specialty Code | Provider Type | |
Multi-Specialty |
261QM1300X | 70 | Clinic or Group Practice |
| NPI # | 1922405406 |
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| LBN Legal business name | SOUTHCENTRAL FOUNDATION | ||||||||
| Authorized official | RONALD OLSON - (EXECUTIVE VICE PRESIDENT FINANCE) | ||||||||
| Entity | Organization | ||||||||
| Organization subpart 1 | Yes | ||||||||
| Enumeration date | 11/26/2014 | ||||||||
| Last updated | 09/18/2023 - About 3 years ago | ||||||||
| Identifiers |
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SOUTHCENTRAL FOUNDATION
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SOUTHCENTRAL FOUNDATION