Specialty |
Taxonomy Code | Specialty Code | Provider Type | |
Primary Care |
261QP2300X |
| NPI Number | 1356788780 |
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| LBN Legal business name | IDA GROVE FAMILY HEALTH CENTER, PLLC | ||||
| Authorized official | MICHAEL LUFT - (OWNER) | ||||
| Entity | Organization | ||||
| Organization subpart 1 | Yes | ||||
| Enumeration date | 05/24/2013 | ||||
| Last updated | 07/16/2013 - About 13 years ago | ||||
| Identifiers |
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