Healthcare Provider Details

I. General information

NPI: 1720108541
Provider Name (Legal Business Name): PEOPLES COMMUNITY HEALTH CLINIC, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2007
Last Update Date: 10/30/2019
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: 319-272-4489
Mailing address:
  • Phone: 319-874-3000
  • Fax: 319-874-3489

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number406
License Number StateIA

VIII. Authorized Official

Name: CHRIS KEMP
Title or Position: COO
Credential:
Phone: 319-874-3000