Healthcare Provider Details

I. General information

NPI: 1871582163
Provider Name (Legal Business Name): COMMUNITY HEALTH CENTER OF SEIA, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2005
Last Update Date: 03/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1706 W AGENCY RD
WEST BURLINGTON IA
52655-1667
US

IV. Provider business mailing address

1706 W AGENCY RD
WEST BURLINGTON IA
52655-1667
US

V. Phone/Fax

Practice location:
  • Phone: 319-752-5540
  • Fax: 319-752-4096
Mailing address:
  • Phone: 319-752-5540
  • Fax: 319-752-4096

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number08186
License Number StateIA

VIII. Authorized Official

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