Specialty |
Taxonomy Code | Specialty Code | Provider Type | |
Rural Health |
261QR1300X | B4[14] | Rural Health Clinic | |
Family Health |
364SF0001X | 89 | Certified Clinical Nurse Specialist | |
Family Medicine |
207Q00000X | 08 | Physician/Family Practice |
| NPI Number | 1497766000 |
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| LBN Legal business name | CLINICO LLC | ||||
| Authorized official | KERRI ELLIS - (OWNER/ADMINISTRATOR) | ||||
| Entity | Organization | ||||
| Organization subpart 1 | No | ||||
| Enumeration date | 08/10/2006 | ||||
| Last updated | 09/30/2021 - About 5 years ago | ||||
| Identifiers |
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