Healthcare Provider Details

I. General information

NPI: 1225290059
Provider Name (Legal Business Name): COMMUNITY HEALTH CENTERS OF SOUTHEASTERN IOWA, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2008
Last Update Date: 08/08/2022
Certification Date: 08/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

241 COLONELS DR
COLUMBUS JUNCTION IA
52738-9702
US

IV. Provider business mailing address

1706 W AGENCY RD
WEST BURLINGTON IA
52655-1667
US

V. Phone/Fax

Practice location:
  • Phone: 319-728-7402
  • Fax: 319-728-7402
Mailing address:
  • Phone: 319-768-5858
  • Fax: 319-753-2301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: RONALD W KEMP
Title or Position: CEO
Credential:
Phone: 319-753-2300