Healthcare Provider Details

I. General information

NPI: 1952917049
Provider Name (Legal Business Name): PEOPLES COMMUNITY HEALTH CLINIC, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2020
Last Update Date: 09/23/2020
Certification Date: 09/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

214 HIGH ST
WATERLOO IA
50703-3908
US

IV. Provider business mailing address

905 FRANKLIN ST
WATERLOO IA
50703-4407
US

V. Phone/Fax

Practice location:
  • Phone: 319-433-2446
  • Fax:
Mailing address:
  • Phone: 319-874-3000
  • Fax:

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: BETH WHITE
Title or Position: HR ADMINISTRATOR
Credential:
Phone: 319-874-3000