Healthcare Provider Details

I. General information

NPI: 1093703639
Provider Name (Legal Business Name): PEOPLES COMMUNITY HEALTH CLINIC, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2005
Last Update Date: 10/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

905 FRANKLIN ST
WATERLOO IA
50703-4407
US

IV. Provider business mailing address

905 FRANKLIN ST
WATERLOO IA
50703-4407
US

V. Phone/Fax

Practice location:
  • Phone: 319-272-4300
  • Fax: 319-272-4321
Mailing address:
  • Phone: 319-874-3000
  • Fax: 319-874-3411

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number StateIA

VIII. Authorized Official

Name: CHRISTINE KEMP
Title or Position: CEO
Credential: CEO
Phone: 319-874-3000