Healthcare Provider Details

I. General information

NPI: 1477819886
Provider Name (Legal Business Name): COMMUNITY HEALTH CARE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2012
Last Update Date: 04/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

708 15TH AVE
EAST MOLINE IL
61244-2134
US

IV. Provider business mailing address

500 W RIVER DR
DAVENPORT IA
52801-1014
US

V. Phone/Fax

Practice location:
  • Phone: 563-327-2015
  • Fax: 563-327-2045
Mailing address:
  • Phone: 563-336-3000
  • Fax: 563-336-3125

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: THOMAS J BOWMAN
Title or Position: CEO
Credential:
Phone: 563-336-3000