MEDICARE: COMMUNITY HEALTH CENTERS OF SOUTHEASTERN IOWA 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
1	261QF0400X	Federally Qualified Health Center (FQHC)

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	35732	OTHER	IA	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1265618805
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMMUNITY HEALTH CENTERS OF SOUTHEASTERN IOWA INC

Provider Business Mailing Address
First Line	:	1706 W AGENCY RD
Second Line	:
City	:	WEST BURLINGTON
State	:	IA
Zip	:	52655-1667
Country	:	US
Telephone Number	:	319-768-5858
Fax Number	:	319-753-2301

Provider Business Practice Location Address
First Line	:	2409 SPRING ST
Second Line	:
City	:	COLUMBUS CITY
State	:	IA
Zip	:	52737-9302
Country	:	US
Telephone Number	:	319-728-7400
Fax Number	:	319-753-2301

Authorized Official
Title or Position	:	CEO
Name	:	MR. ANTONIO FLORES
Credential	:	CEO
Telephone Number	:	319-758-5858

Provider Enumeration Date	:	01/14/2008
Last Update Date	:	01/25/2023

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