Specialty |
Taxonomy Code | Specialty Code | Provider Type | |
Wound Care |
163WW0000X | |||
Internal Medicine |
207R00000X | 11 | Physician/Internal Medicine |
| NPI Number | 1811704448 |
| LBN Legal business name | MOUNTAIN STATES HEALTH ALLIANCE |
| Authorized official | JUANITA HARWOOD - (DIRECTOR) |
| Entity | Organization |
| Organization subpart 1 | No |
| Enumeration date | 12/17/2024 |
| Last updated | 12/17/2024 - More than a year ago |
| Identifiers | n/a |
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MOUNTAIN STATES HEALTH ALLIANCE
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