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NPI Code Detail

MEDICARE: COMMUNITY HEALTH CARE, INC

MEDICARE: COMMUNITY HEALTH CARE, INC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1291U00000XClinical Medical Laboratory
2261QF0400XFederally Qualified Health Center (FQHC)

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1114252012
Entity Type Code : Organization
Provider Name (Legal Business Name) : COMMUNITY HEALTH CARE, INC
Provider Business Mailing Address
First Line : 500 W RIVER DR
Second Line :
City : DAVENPORT
State : IA
Zip : 52801-1014
Country : US
Telephone Number : 563-336-3000
Fax Number : 563-336-3125
Provider Business Practice Location Address
First Line : 2200 3RD AVE
Second Line :
City : ROCK ISLAND
State : IL
Zip : 61201-8840
Country : US
Telephone Number : 309-779-2835
Fax Number : 309-779-2819
Authorized Official
Title or Position : CEO
Name : THOMAS J BOWMAN
Credential :
Telephone Number : 563-336-3000
Provider Enumeration Date : 10/09/2009
Last Update Date : 04/29/2013

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