Specialty |
Taxonomy Code | Specialty Code | Provider Type | |
Rural Health |
261QR1300X | B4[14] | Rural Health Clinic | |
Family Medicine |
207Q00000X | 08 | Physician/Family Practice |
| NPI # | 1487364709 |
| LBN Legal business name | ACUTE CARE CLINIC CLARKRANGE |
| Authorized official | TAMARA EROH - (CREDENTIALING MANAGER) |
| Entity | Organization |
| Organization subpart 1 | Yes |
| Enumeration date | 11/28/2022 |
| Last updated | 11/28/2022 - About 4 years ago |
| Identifiers | n/a |
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