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NPI Code Detail

MEDICARE: EAST CHICAGO COMMUNITY HEALTH CENTER, INC.

MEDICARE: EAST CHICAGO COMMUNITY HEALTH CENTER, 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
1261QM1300XMulti-Specialty Clinic/Center

General Provider Information

NPI Number : 1154381739
Entity Type Code : Organization
Provider Name (Legal Business Name) : EAST CHICAGO COMMUNITY HEALTH CENTER, INC.
Provider Business Mailing Address
First Line : P.O. BOX 59
Second Line :
City : EAST CHICAGO
State : IN
Zip : 46312-0059
Country : US
Telephone Number : 219-397-1196
Fax Number : 219-392-4981
Provider Business Practice Location Address
First Line : 1313 W. CHICAGO AVENUE
Second Line :
City : EAST CHICAGO
State : IN
Zip : 46312-3316
Country : US
Telephone Number : 219-397-1196
Fax Number : 219-392-4981
Authorized Official
Title or Position : CHIEF EXECUTIVE OFFICER
Name : MR. DWAYNE O MITCHELL
Credential : MHA
Telephone Number : 219-392-4900
Provider Enumeration Date : 03/27/2006
Last Update Date : 03/10/2011

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Directions to “EAST CHICAGO COMMUNITY HEALTH CENTER, INC. ” Practice Location

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